Provider Demographics
NPI:1871549261
Name:DOERMAN, RANDALL L (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:DOERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 COLVIN RUN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1872
Mailing Address - Country:US
Mailing Address - Phone:703-757-3870
Mailing Address - Fax:703-757-9879
Practice Address - Street 1:10135 COLVIN RUN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-1872
Practice Address - Country:US
Practice Address - Phone:703-757-3870
Practice Address - Fax:703-757-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
490783Medicare ID - Type Unspecified
B93052Medicare UPIN