Provider Demographics
NPI:1508991985
Name:PRICE, DUDLEY RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:RANDOLPH
Last Name:PRICE
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 1:4049 BIG PASS LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-1880
Mailing Address - Country:US
Mailing Address - Phone:941-505-2995
Mailing Address - Fax:941-505-2995
Practice Address - Street 1:3340 WOODBURN ROAD
Practice Address - Street 2:WOODBURN CENTER FOR CMH
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-573-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010253472084P0800X
ALMD92412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry