Provider Demographics
NPI:1255475646
Name:RANDLE, ROBERT OAKLEY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OAKLEY
Last Name:RANDLE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14728 LAKE TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3631
Mailing Address - Country:US
Mailing Address - Phone:301-871-5705
Mailing Address - Fax:301-871-5706
Practice Address - Street 1:14728 LAKE TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3631
Practice Address - Country:US
Practice Address - Phone:301-871-5705
Practice Address - Fax:301-871-5706
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY572103G00000X, 103TF0200X
VA0810000737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
491344Medicare PIN