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Provider Information for 1457363848

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. RANDI G PLESKOW MD

Gender: FEMALE

Individual NPI: 1457363848

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1457363848
Enumeration Date 2006-08-13
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6058 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6058 | Fax: 617-730-0495
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 3026700
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0206X - Pediatrics Pediatric Gastroenterology MA 54726