Provider Demographics
NPI:1518288232
Name:CANDIA, SUSANA (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:CANDIA
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 1:14 RICE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1332
Mailing Address - Country:US
Mailing Address - Phone:978-939-2035
Mailing Address - Fax:978-939-2039
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-353-6060
Practice Address - Fax:508-363-9236
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1350652085R0202X
MA2662642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110113307AMedicaid