Provider Demographics
NPI:1720098247
Name:TROWBRIDGE, RANDOLPH LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:LEE
Last Name:TROWBRIDGE
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 1:22 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4129
Mailing Address - Country:US
Mailing Address - Phone:203-778-8326
Mailing Address - Fax:203-792-9170
Practice Address - Street 1:22 EAGLE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4129
Practice Address - Country:US
Practice Address - Phone:203-778-8326
Practice Address - Fax:203-792-9170
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030869208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010030869CT02OtherBLUE CROSS
CT2V6141OtherHEALTH NET
CT2V6141OtherHEALTH NET