Provider Demographics
NPI:1013969906
Name:THOMPSON, CANDACE LEWANN (DO)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:LEWANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9 DR OSMAN BABSON ROAD SUITE F
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-890-7373
Mailing Address - Fax:978-890-7372
Practice Address - Street 1:9E DR OSMAN BABSON RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1812
Practice Address - Country:US
Practice Address - Phone:978-890-7373
Practice Address - Fax:978-890-7372
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG81008Medicare UPIN
MAA31500Medicare ID - Type Unspecified