Provider Demographics
NPI:1568694149
Name:RANDOLPH PULMONARY AND SLEEP CLINIC PLLC
Entity Type:Organization
Organization Name:RANDOLPH PULMONARY AND SLEEP CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-633-4020
Mailing Address - Street 1:610 N FAYETTEVILLE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4670
Mailing Address - Country:US
Mailing Address - Phone:336-633-4020
Mailing Address - Fax:336-633-4069
Practice Address - Street 1:610 N FAYETTEVILLE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4670
Practice Address - Country:US
Practice Address - Phone:336-633-4020
Practice Address - Fax:336-633-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4800358OtherUHC
NC016NJOtherBCBS