Provider Demographics
NPI:1649456492
Name:RANDOLPH, CHRISTOPHER EUGENE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 HALES FORD RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5989
Mailing Address - Country:US
Mailing Address - Phone:540-297-1242
Mailing Address - Fax:540-297-1242
Practice Address - Street 1:1317 HALES FORD RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-5989
Practice Address - Country:US
Practice Address - Phone:540-297-1242
Practice Address - Fax:540-297-1242
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705111185171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications