Provider Demographics
NPI:1790984268
Name:RANDOLPH MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:RANDOLPH MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-986-1368
Mailing Address - Street 1:32 SO MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-986-1368
Mailing Address - Fax:781-986-1749
Practice Address - Street 1:32 SO MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-986-1368
Practice Address - Fax:781-986-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724940Medicaid
MAM21230Medicare ID - Type Unspecified