Provider Demographics
NPI:1497799118
Name:HOWARD-CLAUDIO, CANDACE MICHELLE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MICHELLE
Last Name:HOWARD-CLAUDIO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MICHELLE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-2538
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV016072085R0202X
KY406612085R0202X
MS239602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005743Medicaid
KY7100195910Medicaid
OH2659878Medicaid
MS00876318Medicaid
MS00876318Medicaid
WV3810005743Medicaid
OH2659878Medicaid
KYK026340Medicare PIN