Provider Demographics
NPI:1194824177
Name:RANDIVE, VIJAY RAMCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:RAMCHANDRA
Last Name:RANDIVE
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 1:6932J MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411
Mailing Address - Country:US
Mailing Address - Phone:910-799-1249
Mailing Address - Fax:910-799-0641
Practice Address - Street 1:6932J MARKET STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-799-1249
Practice Address - Fax:910-799-1249
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47297207P00000X
TNMD0000026562207P00000X
SC16556207Q00000X
OK17879207Q00000X
NC9300288207Q00000X
NY271183-01207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0265LOtherBCBS
NC70188OtherBCBS
NC8970188Medicaid
NC890265LMedicaid
NC0265LOtherBCBS
F21691Medicare UPIN