Provider Demographics
NPI:1114034477
Name:O'HARA, RANDOLPH CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:CRAIG
Last Name:O'HARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5233
Mailing Address - Country:US
Mailing Address - Phone:310-784-2355
Mailing Address - Fax:310-517-1817
Practice Address - Street 1:23560 CRENSHAW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5233
Practice Address - Country:US
Practice Address - Phone:310-784-2355
Practice Address - Fax:310-517-1817
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67121207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02606ZOtherBLUE SHIELD ZZ NUMBER
CAF85215Medicare UPIN
CAWG67121FMedicare ID - Type Unspecified