Provider Demographics
NPI:1437142551
Name:RANDOLPH, CHRISTOPHER CRONIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CRONIN
Last Name:RANDOLPH
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 1:171 GRANDVIEW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2520
Mailing Address - Country:US
Mailing Address - Phone:203-578-4630
Mailing Address - Fax:203-578-4629
Practice Address - Street 1:171 GRANDVIEW AVE STE 201
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2520
Practice Address - Country:US
Practice Address - Phone:203-578-4630
Practice Address - Fax:203-578-4629
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027063207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00127063600Medicaid
CTB84119Medicare UPIN