Provider Demographics
NPI:1124285184
Name:GESSEL, RANDYL ERIK (PA-C)
Entity type:Individual
Prefix:
First Name:RANDYL
Middle Name:ERIK
Last Name:GESSEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W PATRICK ST STE H
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3974
Mailing Address - Country:US
Mailing Address - Phone:301-662-6478
Mailing Address - Fax:301-662-6427
Practice Address - Street 1:1100 W PATRICK ST STE H
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3974
Practice Address - Country:US
Practice Address - Phone:301-662-6478
Practice Address - Fax:301-662-6427
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01342363A00000X
MDC04452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01342OtherLICENSE
MDC04452OtherLICENSE