Provider Demographics
NPI:1811058084
Name:RANDALL, VIRGINIA FLORY (MD MPH)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:FLORY
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:FLORY
Other - Last Name:ZIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:3804 CHERRY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2905
Mailing Address - Country:US
Mailing Address - Phone:301-260-2702
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF PEDIATRICS, USUHS
Practice Address - Street 2:4301 JONES BRIDGE ROAD
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-295-9733
Practice Address - Fax:301-295-6441
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics