Provider Demographics
NPI:1730447525
Name:RANDALL, JESS T (MD)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:T
Last Name:RANDALL
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 1:319 S. MANNING BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-489-3292
Mailing Address - Fax:518-453-6786
Practice Address - Street 1:740 S LIMESTONE STE L203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6754
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2025-04-01
Deactivation Date:2020-09-30
Deactivation Code:
Reactivation Date:2020-10-07
Provider Licenses
StateLicense IDTaxonomies
NY3066082080P0202X
OH35.151910207RI0011X
KY594062080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology