Provider Demographics
NPI:1154571370
Name:RANDOLPH, DAVID C (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 SIGNAL HILL CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1483
Mailing Address - Country:US
Mailing Address - Phone:513-965-8770
Mailing Address - Fax:513-965-3939
Practice Address - Street 1:5724 SIGNAL HILL CT
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1483
Practice Address - Country:US
Practice Address - Phone:513-965-8770
Practice Address - Fax:513-965-3939
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.038593202C00000X, 208D00000X
TXM6353202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice