Provider Demographics
NPI:1831483825
Name:BERRY-CANDELARIO, JOHN JR (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BERRY-CANDELARIO
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-367-4800
Mailing Address - Fax:704-316-3025
Practice Address - Street 1:10305 HAMPTONS PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7221
Practice Address - Country:US
Practice Address - Phone:704-895-9838
Practice Address - Fax:704-316-3083
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-248422207T00000X
MA278430207T00000X
NC2020-04137207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery