Provider Demographics
NPI:1205206331
Name:MORGAN, CANDACE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CETRONIA RD STE 205N
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:484-426-2600
Mailing Address - Fax:610-336-4379
Practice Address - Street 1:240 CETRONIA RD STE 205N
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9263
Practice Address - Country:US
Practice Address - Phone:484-426-2600
Practice Address - Fax:610-336-4379
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057918363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical