Healthcare Provider Details

I. General information

NPI: 1346436052
Provider Name (Legal Business Name): CANDRICE RACHELLE HEATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW STE 4300
WASHINGTON DC
20060-0002
US

IV. Provider business mailing address

2041 GEORGIA AVE NW STE 4300
WASHINGTON DC
20060-0002
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6725
  • Fax:
Mailing address:
  • Phone: 202-865-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD430770
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberLT4029
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD430770
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD500002692
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: