Provider Demographics
NPI:1417928318
Name:STOLOFF, RANDY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:SCOTT
Last Name:STOLOFF
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 1:200 FORSYTHE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5426
Mailing Address - Country:US
Mailing Address - Phone:910-824-7619
Mailing Address - Fax:910-824-7754
Practice Address - Street 1:200 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5426
Practice Address - Country:US
Practice Address - Phone:910-824-7619
Practice Address - Fax:910-824-7754
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142529207K00000X
MDD0088620207K00000X
NC2014-02205207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417928318Medicaid
NCNCL232AOtherMEDICARE PTAN
GA202I036360Medicare PIN