Provider Demographics
NPI:1770884173
Name:AXELROD, RANDY C (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:C
Last Name:AXELROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:456 WOODARDS FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4307
Mailing Address - Country:US
Mailing Address - Phone:757-546-8029
Mailing Address - Fax:757-546-9053
Practice Address - Street 1:456 WOODARDS FORD RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4307
Practice Address - Country:US
Practice Address - Phone:757-546-8029
Practice Address - Fax:757-546-9053
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049258208000000X
VA01010558702083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics