Basic Information
| Provider Information | |||||||||
| NPI: | 1639179682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437382872 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 OAK RIDGE TURN PIKE | ||||||||
| Address2: | SUITE A-101 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654831093 | ||||||||
| FaxNumber: | 8654828629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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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 | 208800000X | MD0000014439 | TN | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 020247799 | 01 | TN | EEOICP | OTHER | 1669416442 | 01 | TN | GROUP NPI | OTHER | 3106049 | 01 | TN | BLUE CROSS | OTHER | 3025129 | 05 | TN | MEDICAID | CI2260 | 01 | TN | RAILROAD MEDICARE | OTHER | 3106044 | 01 | TN | BLUE CROSS | OTHER |