Provider Demographics
NPI:1114972320
Name:MCLEOD, RANDI J (MD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:J
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-2640
Practice Address - Fax:570-768-3921
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD056652L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA855947OtherHIGHMARK BLUE SHIELD
PA15798530005Medicaid
232809429OtherTRICARE
PA321845OtherHEALTH AMERICA
NY02752156OtherNEW YORK MEDICAID
PA855947OtherKEYSTONE
PA930034292OtherRAILROAD MEDICARE
PA15798530005Medicaid
PA855947OtherKEYSTONE