Provider Demographics
NPI:1568909950
Name:HOSTON, RANDOLPH
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:HOSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 K ST NW
Mailing Address - Street 2:UNIT 824
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5252
Mailing Address - Country:US
Mailing Address - Phone:202-534-9890
Mailing Address - Fax:
Practice Address - Street 1:475 K ST NW
Practice Address - Street 2:UNIT 824
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5252
Practice Address - Country:US
Practice Address - Phone:202-534-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide