Provider Demographics
NPI:1023214913
Name:PETER CANDELORA MD PA
Entity Type:Organization
Organization Name:PETER CANDELORA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CANDELORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-1417
Mailing Address - Street 1:5604 GULF DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4020
Mailing Address - Country:US
Mailing Address - Phone:727-848-1417
Mailing Address - Fax:727-847-7526
Practice Address - Street 1:5604 GULF DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4020
Practice Address - Country:US
Practice Address - Phone:727-848-1417
Practice Address - Fax:727-847-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty