Provider Demographics
NPI:1932144821
Name:STRATTON, RANDALL L (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:STRATTON
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5201
Mailing Address - Fax:740-446-5761
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5201
Practice Address - Fax:740-446-5761
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5386207P00000X
WV15339207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0041067000Medicaid
OH310917085029OtherOH MEDICAID CARESOURCE
OH0665767OtherMOLINA MEDICAID #
OH080040490OtherRR MEDICARE
000000007331OtherANATHEM BCBS
OH000000185318OtherUNISON MEDICAID #
001714042OtherMOUNTAIN STATE BCBS
OH0665767Medicaid
E16758Medicare UPIN
OH0855252Medicare PIN