Provider Demographics
NPI:1245273432
Name:RANDOLPH, BYRON R (MD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:R
Last Name:RANDOLPH
Suffix:
Gender:M
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:PO BOX 52119
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-2119
Mailing Address - Country:US
Mailing Address - Phone:919-956-4000
Mailing Address - Fax:919-956-4535
Practice Address - Street 1:1301 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2325
Practice Address - Country:US
Practice Address - Phone:919-956-4000
Practice Address - Fax:919-956-4535
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970159Medicaid
NC70159OtherBC/BS IND PRO NO
NC2222633Medicare PIN
NCE70204Medicare UPIN