Randall, Glenn R

Randall, Glenn R is an individual health care provider with primary practice located at 277 East Mountain St Summit Eldercare, Worcester MA 01606. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Randall, Glenn R can be contacted via phone (508) 852-2026.

Contact Information

Primary practice address
277 East Mountain St Summit Eldercare Worcester MA 01606
Phone: (508) 852-2026
Fax: (508) 856-7130
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 80026 Massachusetts
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 80026 Massachusetts
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207RH0002X 80026 Massachusetts

Profile Details

NPI number 1033170972
LBN Legal business name Randall, Glenn R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Jan 17th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033170972 NPPES
Other J14922 BLUE SHIELD INDEMNITY
Other J14922 BLUE SHIELD INDEMNITY
Other 110175052 BLUE SHIELD INDEMNITY
Other 27190 BLUE SHIELD INDEMNITY
Other 27190 BLUE SHIELD INDEMNITY
Other 784073 BLUE SHIELD INDEMNITY
Other J14922 BLUE SHIELD INDEMNITY
Other J14922 BLUE SHIELD INDEMNITY
Other 0400961 BLUE SHIELD INDEMNITY
Other 042472266 BLUE SHIELD INDEMNITY
Other 1061182 BLUE SHIELD INDEMNITY
MEDICAID 3131335 BLUE SHIELD INDEMNITY
Other 042472266 BLUE SHIELD INDEMNITY
Other 042472266 BLUE SHIELD INDEMNITY
Other 6633909 BLUE SHIELD INDEMNITY
Other 7001328 BLUE SHIELD INDEMNITY
Other 991122 BLUE SHIELD INDEMNITY
Other AA2364 BLUE SHIELD INDEMNITY

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