Provider Demographics
NPI:1053319608
Name:PALMORE, RANDOLPH HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:HARRIS
Last Name:PALMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 N HAMILTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1204
Mailing Address - Country:US
Mailing Address - Phone:804-359-6880
Mailing Address - Fax:804-359-0611
Practice Address - Street 1:900 N HAMILTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-1204
Practice Address - Country:US
Practice Address - Phone:804-359-6880
Practice Address - Fax:804-359-0611
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5635802Medicaid
VA5635802Medicaid
VA080006735Medicare PIN