1457327728 NPI number — EUGENIO M CANDAL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457327728 NPI number — EUGENIO M CANDAL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CANDAL

Provider First Name:

EUGENIO

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1457327728

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/26/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5 NEPONSET ST FL STREET12

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WORCESTER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01606-2714

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-856-9599

Provider Business Mailing Address Fax Number:

508-854-4998

Provider First Line Business Practice Location Address:

5 NEPONSET ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WORCESTER

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01606-2714

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-856-9599

Provider Business Practice Location Address Fax Number:

508-854-4998

Provider Enumeration Date:

02/27/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  219237 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 042472266 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 7635482 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: J26947 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
• Identifier: A35980 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2023393 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: AA45743 . This is a "HARVARD PILGRIM HLTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 3663592 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 93021 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 2023393 . This is a "WELFARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 375018 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7635482 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".