Provider Demographics
NPI:1043543861
Name:DONNIS, RANDI E (MED)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:E
Last Name:DONNIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH ST.
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:617-284-5130
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH ST.
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-284-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program