Provider Demographics
NPI:1659315216
Name:RANDAZZO, JOSEPHINE (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 LITTLE YORK RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5800
Mailing Address - Country:US
Mailing Address - Phone:937-454-9527
Mailing Address - Fax:937-454-9532
Practice Address - Street 1:4160 LITTLE YORK RD
Practice Address - Street 2:SUITE 20
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5800
Practice Address - Country:US
Practice Address - Phone:937-454-9527
Practice Address - Fax:937-454-9527
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001807207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105833Medicaid
IN000000358581OtherBCBS
IN200126780Medicaid
IN200126780Medicaid
IN187730JMedicare PIN
INF41629Medicare UPIN
INP00206704Medicare PIN