Provider Demographics
NPI:1083752307
Name:RANDHAWA, FAISAL JAWED (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FAISAL
Middle Name:JAWED
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5224
Mailing Address - Country:US
Mailing Address - Phone:410-601-6340
Mailing Address - Fax:410-601-5638
Practice Address - Street 1:2435 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-6340
Practice Address - Fax:410-601-5638
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003381363AS0400X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS589Medicare PIN
MD129252Y8SMedicare PIN