Provider Demographics
NPI:1942389705
Name:LITMAN, RANDY GILBERT (DO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:GILBERT
Last Name:LITMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5569
Mailing Address - Country:US
Mailing Address - Phone:215-219-1748
Mailing Address - Fax:
Practice Address - Street 1:2321 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2101
Practice Address - Country:US
Practice Address - Phone:434-582-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 006880L207R00000X
PAOS006880L207Q00000X
VA0102206847204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007007694Medicaid
PA007007694Medicaid
PAF12292Medicare UPIN