Provider Demographics
NPI:1487838827
Name:RANDAZZO, BRUCE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PAUL
Last Name:RANDAZZO
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 1:1428 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1211
Mailing Address - Country:US
Mailing Address - Phone:484-865-5502
Mailing Address - Fax:
Practice Address - Street 1:1428 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1211
Practice Address - Country:US
Practice Address - Phone:484-865-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 047054-L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology