Provider Demographics
NPI:1962407536
Name:POWERS, RANDOLPH S (MD)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:S
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 BROOKSBY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1438
Mailing Address - Country:US
Mailing Address - Phone:978-536-7850
Mailing Address - Fax:877-280-9727
Practice Address - Street 1:100 BROOKSBY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1438
Practice Address - Country:US
Practice Address - Phone:978-536-7850
Practice Address - Fax:877-280-9727
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80799207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00602018OtherRAILROAD MEDICARE
NH30205089OtherNEW HAMPSHIRE MEDICAID
MAJ31185OtherBLUE CROSS BLUE SHIELD
1962407536OtherBCBS
MA3139298Medicaid
MAAA32263OtherHARVARD PILGRIM HEALTHCAR
NHB07616OtherANTHEM BLUE CROSS
MA0132658OtherEVERCARE
07-02617OtherEVERCARE
0016036OtherNEIGHBORHOOD HEALTH PLAN
1440628OtherCIGNA
1440628OtherHEALTHSOURCE
P00228069OtherRAILROAD MEDICARE
MA080799OtherTUFTS HEALTH PLAN
968005OtherNETWORK HEALTH
968005OtherNETWORK HEALTH
MAJ31185OtherBLUE CROSS BLUE SHIELD