Provider Demographics
NPI:1952663452
Name:RANDALL, LAMAR RAYMOND (PDW)
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:RAYMOND
Last Name:RANDALL
Suffix:
Gender:M
Credentials:PDW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 EASTERN AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7056
Mailing Address - Country:US
Mailing Address - Phone:202-451-8915
Mailing Address - Fax:
Practice Address - Street 1:822 EASTERN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7056
Practice Address - Country:US
Practice Address - Phone:202-451-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant