Charles D Randolph, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

028137 Issued in NY

Practice address

875 Mamaroneck Ave
Suite 302
Mamaroneck, NY 10543-1900

Phone

(914) 835-6004

Fax

(914) 835-6055

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American Mobile Dental, P.C.

  • General Practice Dentistry
  • Oneonta, NY
  • NPI 1700943750
  NPD (past)
• American Mobile Dental, P.C.

  • General Practice Dentistry
  • Oneonta, NY
  • NPI 1922358761
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1164589107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MAMARONECK AVE",
            "address_2": "SUITE 302",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431900",
            "telephone_number": "914-835-6004",
            "fax_number": "914-835-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MAMARONECK AVE",
            "address_2": "SUITE 302",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431900",
            "telephone_number": "914-835-6004",
            "fax_number": "914-835-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CHARLES",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "028137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02577842",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fatima Maria Ramos-Marcuse, NPP, PHD
• Dolores Ramos
• Lisa Elizabeth Ramos, LMSW
• Basmah Rana
• Mary Randall
• Arielle Reiner
• RH Medical PLLC
• Lenette Lekey Rice
• Rise-Up Together Mental Health Counseling
• Wannah Robert

• General Practice Dentistry in Mamaroneck, NY
• Providers in Mamaroneck, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.