Provider Demographics
NPI:1407866171
Name:RANDALL, DANIEL CARL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CARL
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2902
Mailing Address - Country:US
Mailing Address - Phone:978-977-4210
Mailing Address - Fax:978-977-4226
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-977-4210
Practice Address - Fax:978-977-4226
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA238125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001756930Medicaid
PA001756930Medicaid
MA035568Medicare PIN