Provider Demographics
NPI:1225296577
Name:RANDOLPH, JOHN WHITNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WHITNEY
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6 GLEN COVE CRIVE
Mailing Address - Street 2:PENOBSCOT BAY MEDICAL CENTER
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4240
Mailing Address - Country:US
Mailing Address - Phone:207-596-8000
Mailing Address - Fax:207-539-5288
Practice Address - Street 1:6 GLEN COVE DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4240
Practice Address - Country:US
Practice Address - Phone:207-596-8000
Practice Address - Fax:207-593-5288
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2010-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME2098207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine