MEDICARE: DR. RANDOLPH HARRIS PALMORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101046848	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH HARRIS PALMORE M.D.

Provider Business Mailing Address
First Line	:	900 N HAMILTON ST
Second Line	:	SUITE A
City	:	RICHMOND
State	:	VA
Zip	:	23221-1204
Country	:	US
Telephone Number	:	804-359-6880
Fax Number	:	804-359-0611

Provider Business Practice Location Address
First Line	:	900 N HAMILTON ST
Second Line	:	SUITE A
City	:	RICHMOND
State	:	VA
Zip	:	23221-1204
Country	:	US
Telephone Number	:	804-359-6880
Fax Number	:	804-359-0611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	06/17/2010

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