Provider Demographics
NPI:1215082276
Name:MCVAY, RANDI M (MD)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:M
Last Name:MCVAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8575
Mailing Address - Country:US
Mailing Address - Phone:303-721-1670
Mailing Address - Fax:303-721-8117
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:303-721-1670
Practice Address - Fax:303-721-8117
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33201174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO160056849OtherRAILROAD MEDICARE
CO012033OtherKAISER COMMERCIAL NUMBER
CO01332014Medicaid
CO160056849OtherRAILROAD MEDICARE
COF99743Medicare UPIN
COC364478Medicare PIN