Provider Demographics
NPI:1982614822
Name:FRANK, RANDOLPH A JR (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:A
Last Name:FRANK
Suffix:JR
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 1:1715 N GEORGE MASON DR
Mailing Address - Street 2:S-304
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3609
Mailing Address - Country:US
Mailing Address - Phone:703-351-1221
Mailing Address - Fax:703-351-1322
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:S-304
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-351-1221
Practice Address - Fax:703-351-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010425152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00006190OtherMEDICARE RAILROAD
VA010219442Medicaid
VA010219442Medicaid
E06416Medicare UPIN