Provider Demographics
NPI:1942375977
Name:RHOAD, RANDY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:A
Last Name:RHOAD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 CROSSWAYS BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2896
Mailing Address - Country:US
Mailing Address - Phone:757-410-0072
Mailing Address - Fax:757-410-7290
Practice Address - Street 1:1435 CROSSWAYS BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2896
Practice Address - Country:US
Practice Address - Phone:757-410-0072
Practice Address - Fax:757-410-7290
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00Y131C01OtherMEDICARE INDIVIDUAL PTAN
VA010062691Medicaid
VAC10841OtherMEDICARE GROUP PTAN
VA1942375977Medicare UPIN