Provider Demographics
NPI:1518957026
Name:ZEITZER, RANDI J (MD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:J
Last Name:ZEITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:J
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:721 SKIPPACK PIKE STE 3
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1700
Practice Address - Country:US
Practice Address - Phone:484-622-6700
Practice Address - Fax:484-622-6720
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062885L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014008600001Medicaid
PA005281QZ7Medicare PIN
PA1014008600001Medicaid
PAG63355Medicare UPIN