Provider Demographics
NPI:1003444845
Name:RANDOLPH, MARTINE NZUNGIZE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:NZUNGIZE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 HAMILTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4029
Mailing Address - Country:US
Mailing Address - Phone:310-400-2565
Mailing Address - Fax:
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE STE 220A
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7514
Practice Address - Country:US
Practice Address - Phone:866-877-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD98612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty