Provider Demographics
NPI:1578746947
Name:DONNA A. RANDOLPH, MD, P.C.
Entity Type:Organization
Organization Name:DONNA A. RANDOLPH, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-764-4850
Mailing Address - Street 1:5631 BURKE CENTRE PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2234
Mailing Address - Country:US
Mailing Address - Phone:703-764-4850
Mailing Address - Fax:703-764-4853
Practice Address - Street 1:5631 BURKE CENTRE PKWY STE H
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2234
Practice Address - Country:US
Practice Address - Phone:703-764-4850
Practice Address - Fax:703-764-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01026Medicare PIN