Provider Demographics
NPI:1447231584
Name:CAMACHO, CANDICE (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:CAMACHO
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3923
Practice Address - Country:US
Practice Address - Phone:603-594-6337
Practice Address - Fax:603-594-6330
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12291207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30777YOtherANTHEM REFERRING RAN
NHAA12104OtherHPHC PIN
NH30204349Medicaid
NH3668348OtherAETNA PIN
NH465557OtherTUFTS PIN
NH01YP07431NH01OtherANTHEM ACES PIN
NH5796013OtherCIGNA PIN
NHAA12104OtherHPHC PIN
NH01YP07431NH01OtherANTHEM ACES PIN