Provider Demographics
NPI:1407878846
Name:FALLS, RANDALL KEITH (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:KEITH
Last Name:FALLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20764
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0077
Mailing Address - Country:US
Mailing Address - Phone:540-772-4448
Mailing Address - Fax:540-772-0410
Practice Address - Street 1:4519 BRAMBLETON AVE
Practice Address - Street 2:SUITE # 302
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3436
Practice Address - Country:US
Practice Address - Phone:540-772-4448
Practice Address - Fax:540-772-0410
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041068208100000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508030081OtherMEDICAID GIN
VA1407878846Medicaid
B07607Medicare UPIN
VA1508030081OtherMEDICAID GIN
VA1407878846Medicaid
P00770386Medicare PIN