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Provider Information for 1396706859

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ADRIENNE G RANDOLPH MD, MSC

Gender: FEMALE

Individual NPI: 1396706859

Calendar   Last Updated:  2007-08-13
  Certification Date: 

Details

Name Value
NPI 1396706859
Enumeration Date 2006-03-31
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-7237 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 3169022
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0203X - Pediatrics Pediatric Critical Care Medicine MA 154233