Provider Demographics
NPI:1225297039
Name:MAK, CANDICE TRACI (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:TRACI
Last Name:MAK
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 1:6740 ALEXANDER BELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2253
Mailing Address - Country:US
Mailing Address - Phone:410-997-8444
Mailing Address - Fax:410-997-8832
Practice Address - Street 1:6740 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2253
Practice Address - Country:US
Practice Address - Phone:410-997-8444
Practice Address - Fax:410-997-8832
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology