Provider Demographics
NPI:1912041369
Name:DUPONT, MARY CANDACE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CANDACE
Last Name:DUPONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:STE 1510
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-654-5530
Mailing Address - Fax:301-654-5540
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:STE 1510
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-654-5530
Practice Address - Fax:301-654-5540
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
340017912OtherRR MEDICARE
G02060Medicare ID - Type UnspecifiedGROUP NUMBER
340017912OtherRR MEDICARE
G15268Medicare UPIN