Provider Demographics
NPI:1376547729
Name:CANDELORA, PETER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:CANDELORA
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 1:5145 DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-7013
Mailing Address - Country:US
Mailing Address - Phone:727-848-1417
Mailing Address - Fax:727-847-7526
Practice Address - Street 1:5145 DEER PARK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-7013
Practice Address - Country:US
Practice Address - Phone:727-848-1417
Practice Address - Fax:727-847-7526
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079772207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063480800Medicaid
FL08830YMedicare ID - Type Unspecified
FLB63812Medicare UPIN