Provider Demographics
NPI:1811981814
Name:HASTEDT, RANDALL C (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:HASTEDT
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:PO BOX 20452
Mailing Address - Street 2:COPA-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-888-7874
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:MT. CARMEL WEST HOSPITAL PATHOLOGY DEPT.
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-234-1300
Practice Address - Fax:614-234-2931
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35037545207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0552058Medicaid
OH220005334OtherRR MEDICARE
OH0713197Medicaid
OH118238OtherANTHEM BCBS
OH0713197Medicaid
OH220005334OtherRR MEDICARE