Provider Demographics
NPI:1376788554
Name:RADA, RANDOLF LYLE
Entity Type:Individual
Prefix:MR
First Name:RANDOLF
Middle Name:LYLE
Last Name:RADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 BUTTS STATION RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3001
Mailing Address - Country:US
Mailing Address - Phone:757-435-8081
Mailing Address - Fax:
Practice Address - Street 1:1453 BUTTS STATION RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3001
Practice Address - Country:US
Practice Address - Phone:757-435-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications