Provider Demographics
NPI:1235215377
Name:RANDOLPH EAR, NOSE & THROAT ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:RANDOLPH EAR, NOSE & THROAT ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-625-1007
Mailing Address - Street 1:124 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5440
Mailing Address - Country:US
Mailing Address - Phone:336-625-1007
Mailing Address - Fax:
Practice Address - Street 1:139 W. SWANNANOA AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298
Practice Address - Country:US
Practice Address - Phone:336-622-5492
Practice Address - Fax:336-625-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty