Provider Demographics
NPI:1699722702
Name:PLONA, RANDY PETER (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:PETER
Last Name:PLONA
Suffix:
Gender:M
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:PO BOX 74224
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:216-383-6480
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:960 CLAGUE RD STE 1100B
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1590
Practice Address - Country:US
Practice Address - Phone:216-383-0100
Practice Address - Fax:216-383-6481
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007598P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341542312098OtherCARESOURCE
OH000000392507OtherANTHEM BC/BS
OH2357248Medicaid
OH378646OtherWELLCARE
OHP00401083OtherRAILROAD CARE
OH4095371Medicare ID - Type Unspecified
OH4095377Medicare PIN
OH2357248Medicaid