Provider Demographics
NPI:1073675278
Name:RANDLETT, DIANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:RANDLETT
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:462 FIRST AVE & 27TH ST.
Mailing Address - Street 2:BELLEVUE HOSPITAL CENTER, MEDICINE MODULE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-1685
Mailing Address - Fax:212-562-1597
Practice Address - Street 1:462 FIRST AVE
Practice Address - Street 2:BELLEVUE HOSPITAL PRIMARY CARE CLINIC, 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-1685
Practice Address - Fax:212-562-1597
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI51809Medicare UPIN