Provider Demographics
NPI:1285655720
Name:MITTLEMAN, RANDI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LYNN
Last Name:MITTLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 FRAZER DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4763
Mailing Address - Country:US
Mailing Address - Phone:267-291-4220
Mailing Address - Fax:215-295-2704
Practice Address - Street 1:54 FRIENDS LN STE 114
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3403
Practice Address - Country:US
Practice Address - Phone:215-431-4847
Practice Address - Fax:215-295-2704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069088L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01755217Medicaid
PA047501Medicare UPIN
PA01755217Medicaid