Provider Demographics
NPI:1487654919
Name:SUAREZ, RANDALL STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:STEVEN
Last Name:SUAREZ
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 1:2720 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4810
Mailing Address - Country:US
Mailing Address - Phone:803-936-7230
Mailing Address - Fax:803-936-8097
Practice Address - Street 1:146 N HOSPITAL DR
Practice Address - Street 2:SUITE 140
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7230
Practice Address - Fax:803-936-8097
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11018207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110187Medicaid
SCC611980281Medicare ID - Type Unspecified
C61198Medicare UPIN