Provider Demographics
NPI:1033169370
Name:CANDELA, STEPHEN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:CANDELA
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 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4131
Mailing Address - Country:US
Mailing Address - Phone:910-640-1022
Mailing Address - Fax:910-640-1448
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4131
Practice Address - Country:US
Practice Address - Phone:910-640-1022
Practice Address - Fax:910-640-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27776207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921030Medicaid
NC8921030Medicaid
NC203127Medicare ID - Type Unspecified