Provider Demographics
NPI:1447211040
Name:HILL, RANDALL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAMES
Last Name:HILL
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 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3302
Mailing Address - Country:US
Mailing Address - Phone:304-346-4455
Mailing Address - Fax:304-346-4457
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3302
Practice Address - Country:US
Practice Address - Phone:304-346-4455
Practice Address - Fax:304-346-4457
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV408466OtherCARELINK COMMERCIAL
WV37213OtherCARELINK MEDICAID
WV4245376OtherAETNA
WV925491OtherMAMSI
WV001794375OtherBCBS PIN#
WV000687821OtherBCBS INDIVIDUAL ID
WV11101421OtherCAQH
WV3810004470Medicaid
WVBH2352398OtherDEA #
WV2031477Medicare PIN
WV925491OtherMAMSI
WV2031471Medicare PIN
WV2031475Medicare PIN
WV2031472Medicare PIN
WV000687821OtherBCBS INDIVIDUAL ID
WV37213OtherCARELINK MEDICAID
WV0683685Medicare PIN
WV0683684Medicare PIN
WV408466OtherCARELINK COMMERCIAL
WV3810004470Medicaid