Provider Demographics
NPI:1497753321
Name:HARRIS, RANDALL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
Last Name:HARRIS
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 1:224 W EXCHANGE ST STE 380
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1796
Mailing Address - Country:US
Mailing Address - Phone:330-344-6676
Mailing Address - Fax:330-434-3611
Practice Address - Street 1:224 W EXCHANGE ST STE 380
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1796
Practice Address - Country:US
Practice Address - Phone:330-344-6676
Practice Address - Fax:330-434-3611
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060784207RC0200X, 207RP1001X
OH35060784 025788208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0846599Medicaid
OH0738173Medicare PIN
OHH088580Medicare PIN
OHF03234Medicare UPIN