Provider Demographics
NPI:1801383088
Name:CANDRIA CONSULTING AND HOLDINGS INC,
Entity Type:Organization
Organization Name:CANDRIA CONSULTING AND HOLDINGS INC,
Other - Org Name:MASSACHUSETTS FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCELLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-629-2806
Mailing Address - Street 1:53 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1448
Mailing Address - Country:US
Mailing Address - Phone:617-629-2806
Mailing Address - Fax:
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1448
Practice Address - Country:US
Practice Address - Phone:617-629-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABL17-000173213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty