Provider Demographics
NPI:1639179682
Name:PEARSON, RANDALL E (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 CROSSROADS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5437
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:
Practice Address - Street 1:800 OAK RIDGE TURN PIKE
Practice Address - Street 2:SUITE A-101
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6927
Practice Address - Country:US
Practice Address - Phone:865-483-1093
Practice Address - Fax:865-482-8629
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014439208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN020247799OtherEEOICP
TN1669416442OtherGROUP NPI
TN3106049OtherBLUE CROSS
TN3025129Medicaid
TNCI2260OtherRAILROAD MEDICARE
TN3106044OtherBLUE CROSS
TN3714750Medicare PIN
TN3106044OtherBLUE CROSS
TNCI2260OtherRAILROAD MEDICARE
TN1669416442OtherGROUP NPI
TN3025129Medicaid