Provider Demographics
NPI:1497195341
Name:ELDRIDGE, RANDALL THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:THOMAS
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 TATE BLVD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1385
Mailing Address - Country:US
Mailing Address - Phone:828-304-0400
Mailing Address - Fax:828-304-0142
Practice Address - Street 1:1501 TATE BLVD SE STE 203
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1385
Practice Address - Country:US
Practice Address - Phone:828-304-0400
Practice Address - Fax:828-304-0142
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006463213E00000X
NC627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCS754AMedicare PIN