Provider Demographics
NPI:1679567325
Name:LESTER, RANDALL V (MD)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:V
Last Name:LESTER
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 1:510 CHERRY ST.
Mailing Address - Street 2:SUITE 206, BLDG A
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701
Mailing Address - Country:US
Mailing Address - Phone:304-327-1888
Mailing Address - Fax:304-327-1889
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:SUITE 206, BLDG A
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-327-1888
Practice Address - Fax:304-327-1889
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010574872086S0129X
IN01066693A2086S0129X
WV126122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200947190Medicaid
IN000000621007OtherANTHEM
VA010136563Medicaid
VA010315590Medicaid
INP00742904OtherRR MEDICARE
IN4410255OtherAETNA
VA010283922Medicaid
WV0128609000Medicaid
VAP00283051Medicare PIN
IN227950E9Medicare PIN
IN000000621007OtherANTHEM
IN200947190Medicaid