Provider Demographics
NPI:1780685354
Name:STEVENS, RANDY E (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LONGVIEW AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5002
Mailing Address - Country:US
Mailing Address - Phone:914-681-2727
Mailing Address - Fax:914-681-2795
Practice Address - Street 1:2 LONGVIEW AVENUE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-681-2727
Practice Address - Fax:914-681-2795
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1761212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F52338Medicare UPIN
49H761Medicare ID - Type Unspecified