Provider Demographics
NPI:1568810935
Name:BROUSSARD-STEINBERG, CANDACE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:BROUSSARD-STEINBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MARIE
Other - Last Name:BROUSSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1250 HANCOCK ST STE 505S
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:781-253-7165
Mailing Address - Fax:781-253-7166
Practice Address - Street 1:1250 HANCOCK ST STE 505S
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:781-253-7165
Practice Address - Fax:781-253-7166
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017761207N00000X
IN01084188A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201369530Medicaid