Provider Demographics
NPI:1750302212
Name:CANDELL, PETER LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LAWRENCE
Last Name:CANDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6562
Mailing Address - Country:US
Mailing Address - Phone:510-521-2300
Mailing Address - Fax:510-521-3950
Practice Address - Street 1:2433 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6562
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:510-521-3950
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50882Medicare UPIN