Provider Demographics
NPI:1558355420
Name:RANDLE, CORA INETTIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORA
Middle Name:INETTIE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORA
Other - Middle Name:INETTIE
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:421 KATES WAY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1636
Mailing Address - Country:US
Mailing Address - Phone:302-659-0653
Mailing Address - Fax:
Practice Address - Street 1:300 TUSKEGEE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER AFB
Practice Address - State:DE
Practice Address - Zip Code:19902-5300
Practice Address - Country:US
Practice Address - Phone:302-677-2525
Practice Address - Fax:302-677-2526
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006857L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine