DR. RANDOLPH HARLEN ROBERTSON (NPI# 1164448239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164448239 |
| Entity Type | Individual |
| Full Name | DR. RANDOLPH HARLEN ROBERTSON |
| Credential | MD |
| Practice Address |
6119 W Jefferson Blvd Fort Wayne IN 46804-3072 |
| Mailing Address |
142 W 5th St Cookeville TN 38501-1760 |
| Practice Telephone | 2604321568 |
| Practice Fax Number | 2604324969 |
| Mailing Telephone | 9315282541 |
| Mailing Fax Number | 9315268814 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
18129 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0050269 | 05 | |
| TN | RAILROAD MEDICARE | 300114288 | 01 |
| TN | 3037577 | 05 | |
| IN | 201023920 | 05 | |
| TN | BCBS | 3156107 | 01 |
| Street Address |
6119 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-3072 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124002746 | Steven L Hossler | Radiology | 6119 W Jefferson Blvd, Fort Wayne, IN 46804-3072 | 2005-12-06 |
| 1255516670 | Linda S Hippenhammer | Radiology | 6119 W Jefferson Blvd, Fort Wayne, IN 46804-3072 | 2008-01-03 |
| 1487625653 | Diane Dierdre Daly | Radiology | 6119 W Jefferson Blvd, Fort Wayne, IN 46804-3072 | 2006-01-27 |
| 1710958848 | John Raphael Kim | Radiology | 6119 W Jefferson Blvd, Fort Wayne, IN 46804-3072 | 2006-01-27 |
| 1205807344 | John Charles Rock | Radiology | 6119 W Jefferson Blvd, Fort Wayne, IN 46804-3072 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376789420 | Richard Frederick Fox | Radiology | 6226 Devils Hollow Rd., Fort Wayne, IN 46814 | 2008-12-19 |
| 1578607149 | Garland Richard Brown | Radiology | 1007 Three Rivers N, Fort Wayne, IN 46802-1334 | 2007-02-16 |
| 1932205077 | Kavita K Erickson | Radiology | 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2006-09-16 |
| 1033226154 | Alan S. Cooperman | Radiology | 14110 Spring Hollow Rd, Fort Wayne, IN 46814-9767 | 2006-08-24 |
| 1336174598 | Mitchell E F Travis | Radiology | 10517 Maple Springs Cv, Fort Wayne, IN 46845-2132 | 2006-07-12 |
| 1023062130 | Gregg R Mattison | Radiology | 3707 New Vision Drive, Fort Wayne, IN 46895-5602 | 2006-05-22 |
| 1184678278 | Charles Tsai | Radiology | 109 Chestnut Hills Pkwy, Fort Wayne, IN 46814-8924 | 2006-05-22 |
| 1922061613 | Mri Center - Fort Wayne Radiology Inc | Radiology | 2110 Carew St, Fort Wayne, IN 46805-4712 | 2006-04-11 |
| 1861455669 | Open View Mri, LLC | Radiology | 10202 Coldwater Rd, Fort Wayne, IN 46825-2076 | 2006-04-11 |
| 1902870033 | Jay T Jones | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2006-02-15 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on DR. RANDOLPH HARLEN ROBERTSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.