Provider Demographics
NPI:1326124504
Name:MEADOR, RANDALL GENE (ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:GENE
Last Name:MEADOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 MERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2220
Mailing Address - Country:US
Mailing Address - Phone:304-598-9225
Mailing Address - Fax:304-293-3366
Practice Address - Street 1:3521 MONONGAHELA BLVD
Practice Address - Street 2:COLISEUM ROOM 34
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3021
Practice Address - Country:US
Practice Address - Phone:304-293-2737
Practice Address - Fax:304-293-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist