Provider Demographics
NPI:1760859409
Name:A J CANDELORE DO PLLC
Entity Type:Organization
Organization Name:A J CANDELORE DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANDELORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-883-5149
Mailing Address - Street 1:617 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9714
Mailing Address - Country:US
Mailing Address - Phone:207-883-5149
Mailing Address - Fax:207-883-7885
Practice Address - Street 1:617 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9714
Practice Address - Country:US
Practice Address - Phone:207-883-5149
Practice Address - Fax:207-883-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty