Provider Demographics
NPI:1992959274
Name:WITHEROW, RANDY JAMES (CST-CFA)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:JAMES
Last Name:WITHEROW
Suffix:
Gender:M
Credentials:CST-CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-8255
Mailing Address - Country:US
Mailing Address - Phone:914-938-4043
Mailing Address - Fax:
Practice Address - Street 1:32 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-8255
Practice Address - Country:US
Practice Address - Phone:914-938-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant