Provider Demographics
NPI:1538715503
Name:WITCHER, RANDY
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:WITCHER
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 1:1429 WADE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24139-2521
Mailing Address - Country:US
Mailing Address - Phone:434-420-5991
Mailing Address - Fax:
Practice Address - Street 1:1429 WADE RD
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24139-2521
Practice Address - Country:US
Practice Address - Phone:434-420-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver