Provider Demographics
NPI:1407929698
Name:RANDALL, JOSEPH C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:RANDALL
Suffix:JR
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 1:1829 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6320
Mailing Address - Country:US
Mailing Address - Phone:410-602-9850
Mailing Address - Fax:410-602-9857
Practice Address - Street 1:2629 RIVA RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7428
Practice Address - Country:US
Practice Address - Phone:410-266-1000
Practice Address - Fax:410-573-4067
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042752207R00000X
DCMD17299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81629Medicare UPIN
017763K92Medicare ID - Type Unspecified