Provider Demographics
NPI:1568628840
Name:RANDALL, RAMONA A (CMT, CPT)
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:A
Last Name:RANDALL
Suffix:
Gender:F
Credentials:CMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3214
Mailing Address - Country:US
Mailing Address - Phone:240-421-4216
Mailing Address - Fax:
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:SUITE 206
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-828-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03417247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other