Provider Demographics
NPI:1770582876
Name:DYER, CANDACE L (MD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:L
Last Name:DYER
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 1:390 TOLL GATE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-739-8010
Mailing Address - Fax:401-739-6087
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:STE.200
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-739-8010
Practice Address - Fax:401-739-6087
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI6126208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000783Medicaid
RI29067-8OtherBLUE CROSS PROVIDER ID
RI003673OtherBLUE CHIP PROVIDER ID
RI003673OtherBLUE CHIP PROVIDER ID