Provider Demographics
NPI:1740369388
Name:HARRISON, RANDOLPH BRYHN (MD)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:BRYHN
Last Name:HARRISON
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 1:31 WILLOWOOD DR APT 101
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4738
Mailing Address - Country:US
Mailing Address - Phone:757-766-1552
Mailing Address - Fax:
Practice Address - Street 1:31 WILLOWOOD DR
Practice Address - Street 2:APT. 101
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4738
Practice Address - Country:US
Practice Address - Phone:757-766-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040040207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology