Basic Information
| Provider Information | |||||||||
| NPI: | 1518982537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARRICK | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 931286 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441931494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887199012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1655 W MARKET ST | ||||||||
| Address2: | 510 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443137004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308677274 | ||||||||
| FaxNumber: | 3304937123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34-003151 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0473170 | 05 | OH | MEDICAID |