Beryl L Randolph,M.D., P.C.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

01055463 Issued in IN

Legal business name

BERYL L RANDOLPH,M.D., P.C.

Practice address

800 Broadway
Suite 100
Fort Wayne, IN 46802-2149

Phone

(260) 425-3102

NPI assigned

Jun 17, 2008

Last updated

Jun 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Beryl Lynn Randolph, M.D.

Title

Owner

Phone

(260) 338-2048

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1902067598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BROADWAY",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022149",
            "telephone_number": "260-425-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BROADWAY",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022149",
            "telephone_number": "260-425-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERYL L RANDOLPH,M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "BERYL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-338-2048",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01055463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Fort Wayne, IN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.