Provider Demographics
NPI:1205945219
Name:TRUITT, RANDOLPH N JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:N
Last Name:TRUITT
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1400 BLACKHORSE HILL RD
Mailing Address - Street 2:COATESVILLE V.A. MEDICAL CENTER
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2040
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-380-4318
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:COATESVILLE V.A. MEDICAL CENTER
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-380-4318
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-23
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Provider Licenses
StateLicense IDTaxonomies
PAMA000207L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATR167741Medicare UPIN