Provider Demographics
NPI:1932167947
Name:WEYRICH, RANDALL P (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:P
Last Name:WEYRICH
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 1:6602 SEABIRD WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3003
Mailing Address - Country:US
Mailing Address - Phone:304-639-3427
Mailing Address - Fax:
Practice Address - Street 1:6602 SEABIRD WAY
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3003
Practice Address - Country:US
Practice Address - Phone:304-639-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12455207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B88951Medicare UPIN
WV9331631Medicare ID - Type Unspecified
B88951Medicare UPIN