Provider Demographics
NPI:1518931963
Name:HELMHOLZ, RANDOLPH H (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:H
Last Name:HELMHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 NORTHPORT AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6095
Mailing Address - Country:US
Mailing Address - Phone:207-930-6751
Mailing Address - Fax:207-930-6753
Practice Address - Street 1:116 NORTHPORT AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6095
Practice Address - Country:US
Practice Address - Phone:207-930-6751
Practice Address - Fax:207-930-6753
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039876208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010039876CT02OtherBCBS
CT001398769Medicaid
COP00227874OtherMEDICARE RAILROAD
CTH48313Medicare UPIN
CT020001603Medicare ID - Type Unspecified