Provider Demographics
NPI:1154489128
Name:RANDOLPH, PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10614
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-0614
Mailing Address - Country:US
Mailing Address - Phone:301-593-3200
Mailing Address - Fax:
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE STE 504
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2618
Practice Address - Country:US
Practice Address - Phone:301-593-3200
Practice Address - Fax:301-593-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00831231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00281897OtherMEDICARE RAILROAD
MD3973773OtherAETNA
MD5016973OtherCIGNA
MDK098 0001OtherCAREFIRST BCBS
MDK098 0001OtherCAREFIRST BCBS