Provider Demographics
NPI:1497724249
Name:TROWBRIDGE, RANDALL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:TROWBRIDGE
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:PO BOX 660242
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0001
Mailing Address - Country:US
Mailing Address - Phone:317-927-5770
Mailing Address - Fax:317-927-5792
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-927-5770
Practice Address - Fax:317-927-5792
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039019A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100349980Medicaid
000000558901OtherANTHEM
000000558901OtherANTHEM
IN224290AMedicare PIN
IN256630EMedicare PIN
P00199514Medicare PIN