Provider Demographics
NPI:1841253044
Name:ALDRICH, HARRY RANDOLPH (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:RANDOLPH
Last Name:ALDRICH
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 1:6200 SUNSET DRIVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:305-666-4633
Mailing Address - Fax:305-667-1675
Practice Address - Street 1:6200 SUNSET DRIVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:305-666-4633
Practice Address - Fax:305-667-1675
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64948207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26592TMedicare ID - Type Unspecified
FLE87273Medicare UPIN