Provider Demographics
NPI:1902888258
Name:FOREHAND, JOHN RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDOLPH
Last Name:FOREHAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1100
Mailing Address - Country:US
Mailing Address - Phone:276-964-1229
Mailing Address - Fax:276-964-1354
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-964-1229
Practice Address - Fax:276-964-1354
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20325207K00000X, 207RP1001X, 208000000X
KY38298207K00000X, 207RP1001X, 208000000X
VA0101030006207RP1001X, 208000000X, 207K00000X
TN50578207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN50578OtherMEDICAL LICENSE
083360OtherANTHEM BCBS
VA010323118Medicaid
WV0112319-000Medicaid
KY64664279Medicaid
VA6045359Medicaid