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NPI Code Detail

MEDICARE: AMELIA H. RANDALL MD

MEDICARE: AMELIA H. RANDALL MD
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
1207L00000XAnesthesiology Physician0101251797VA
2207LP3000XPediatric Anesthesiology Physician0101251797VA
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1811012586
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMELIA H. RANDALL MD
Provider Business Mailing Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1910
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1971
Country : US
Telephone Number : 757-668-7320
Fax Number : 757-668-9735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 02/18/2019

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