Provider Demographics
NPI:1487641700
Name:RANDALL, MARCUS EDDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:EDDIE
Last Name:RANDALL
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 1:800 ROSE STREET
Mailing Address - Street 2:DEPARTMENT OF RADIATION MEDICINE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-257-7618
Mailing Address - Fax:859-257-7483
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:DEPARTMENT OF RADIATION MEDICINE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-257-7618
Practice Address - Fax:859-257-7483
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01042349A2085R0001X
KY405182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC70124OtherBCBS NC
NC8970124Medicaid
NC8970124Medicaid
NC2036577Medicare ID - Type Unspecified