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General NPI Number Information
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NPI Number | 1528164845
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Entity Type | Individual
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Provider Name | MELINDA L. RANDALL M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 333 EAST STREET
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City | PITTSFIELD
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State | MA
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Zip | 01202
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Country | US
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Telephone | 413-499-0412
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 4219
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City | PITTSFIELD
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State | MA
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Zip | 01202
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Country | US
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Telephone | 413-499-0412
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Fax | 413-499-0979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 039684
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 240550
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License Number State | MA
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