Provider Demographics
NPI:1275791188
Name:NORWOOD WILSON, CANDACE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:DENISE
Last Name:NORWOOD WILSON
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 1:193 STONER AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-876-3355
Mailing Address - Fax:410-848-3647
Practice Address - Street 1:193 STONER AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-876-3355
Practice Address - Fax:410-876-3355
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446434207V00000X
MDD80630207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30129049OtherAMERIHEALTH MERCY - WMG
PA418688OtherUPMC
PA1611665OtherGATEWAY
PA2720717OtherHIGHMARK BLUE SHIELD - STANDARD
PA30141834OtherAMERIHEALTH MERCY - YHCHC
PA102748078Medicaid
PA30132003OtherAMERIHEALTH MERCY - YH
PA30141834OtherAMERIHEALTH MERCY - YHCHC
PA102748078Medicaid