Provider Demographics
NPI:1467475970
Name:KANDLE, MICHAEL ROSS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROSS
Last Name:KANDLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ORCHARD DRIVE
Mailing Address - Street 2:P.O. BOX 709
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-0709
Mailing Address - Country:US
Mailing Address - Phone:603-868-5700
Mailing Address - Fax:603-868-5700
Practice Address - Street 1:11 ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-0709
Practice Address - Country:US
Practice Address - Phone:603-868-5700
Practice Address - Fax:603-868-5700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH653103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002496Medicaid
NHRE2496Medicare ID - Type Unspecified