Provider Demographics
NPI:1245223601
Name:PATE, CANDACE ROWLAND (MD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:ROWLAND
Last Name:PATE
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 1:7023 OLD JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-320-1353
Mailing Address - Fax:804-320-6636
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010542792080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3119833OtherMAMSI
VA200257OtherSOUTHERN HEALTH
VA6736726OtherSENTARA
VA6736726Medicaid
VA437065OtherANTHEM
VA6736726OtherVIRGINIA PREMIER
VA6736726OtherSENTARA