Provider Demographics
NPI:1093726382
Name:CANDIB, LUCY M (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:CANDIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:MEDICAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7700
Mailing Address - Fax:508-860-7929
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:MEDICAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7700
Practice Address - Fax:508-860-7929
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0001114OtherNHP
MA0080097OtherEVERCARE-GROUP
MA1300709OtherCMSP-GROUP
MA2078639014OtherUNITED HEALTH CARE
MAY10141OtherBCBS-GROUP
MA0006767OtherNHP-GROUP
MA042485308OtherNETWORK HEALTH-GROUP
MA23617OtherCMSP
MA99734101OtherNETWORK HEALTH
MA0105213OtherEVERCARE
MA1300709Medicaid
MA347292OtherCIGNA
MAN01717OtherBCBS
MA71720OtherHARVARD PILGRIM
MA347292OtherCIGNA
MA221804Medicare ID - Type UnspecifiedPART A-GROUP
MA71720OtherHARVARD PILGRIM
MA0105213OtherEVERCARE
MA1300709OtherCMSP-GROUP