Provider Demographics
NPI:1720132756
Name:STEPHEN J CANDELA PA
Entity Type:Organization
Organization Name:STEPHEN J CANDELA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-640-1022
Mailing Address - Street 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4131
Mailing Address - Country:US
Mailing Address - Phone:910-640-1022
Mailing Address - Fax:910-640-1448
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4131
Practice Address - Country:US
Practice Address - Phone:910-640-1022
Practice Address - Fax:910-640-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27776207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD62866Medicare UPIN
NCS96116Medicare UPIN