Provider Demographics
NPI:1124857081
Name:RANDALL, OBED
Entity type:Individual
Prefix:
First Name:OBED
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MIDDLEFORD ROAD
Mailing Address - Street 2:STE 401
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3665
Mailing Address - Country:US
Mailing Address - Phone:008-188-6808
Mailing Address - Fax:866-229-0237
Practice Address - Street 1:29787 JOHN J WILLIAMS HIGHWAY, UNIT #8
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1996
Practice Address - Country:US
Practice Address - Phone:800-818-8680
Practice Address - Fax:866-229-0237
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty