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RANDALL DERMATOLOGY PC NPI 1245340488


NPI Information

NPI: 1245340488
Provider Name: RANDALL DERMATOLOGY, PC
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 15D0910366

Address:
124 SAGAMORE PKWY W
WEST LAFAYETTE BRA, IN
ZIP 47906
Phone: (765) 463-6722
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RANDALL DERMATOLOGY, PC is a dermatology in West Lafayette Bra, IN. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. RANDALL DERMATOLOGY, PC NPI is 1245340488. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

124 SAGAMORE PKWY W
WEST LAFAYETTE BRA, IN
ZIP 47906-569
Phone: (765) 463-6722
Fax: (765) 463-0905

The provider's authorized official is John K Randall .
The authorized official title is President/owner and has the following contact phone number (765) 463-6722.

The CLIA number assigned to this NPI record is 15D0910366 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology01042716INDIANAYes
2207ND0101XDermatologyMOHS-Micrographic Surgery01042716INDIANAX
3363A00000XPhysician Assistant10000699AINDIANAX
4363L00000XNurse Practitioner71001017AINDIANAX
5363L00000XNurse PractitionerINDIANAX

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

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