DR. RANDOLPH HARLEN ROBERTSON MD NPI 1164448239

NPI Information

NPI: 1164448239
Provider Name: DR. RANDOLPH HARLEN ROBERTSON, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
6119 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804
Phone: (260) 432-1568
Get Directions

DR. Randolph Harlen Robertson, MD is a diagnostic radiology radiology in Fort Wayne, IN. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Randolph Harlen Robertson, MD NPI is 1164448239. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6119 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804-072
Phone: (260) 432-1568
Fax: (260) 432-4969

The NPI 1164448239 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/14/2006 and was last updated on 2/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	18129	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	M400048362	MEDICARE PIN	INDIANA
2	MI1209040	MEDICARE PIN	MICHIGAN
3	3037571	MEDICARE ID-TYPE UNSPECIFIED	TENNESSEE
4	3037577	MEDICAID	TENNESSEE
5	P00950297	MEDICARE PIN	INDIANA
6	3156107	OTHER	TENNESSEE	BCBS
7	300114288	OTHER	TENNESSEE	RAILROAD MEDICARE
8	B00078	MEDICARE UPIN	TENNESSEE
9	0050269	MEDICAID	OHIO
10	201023920	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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