Healthcare Provider Details

I. General information

NPI: 1306951371
Provider Name (Legal Business Name): BRIAN MCCANDLESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EMMA LN STE 103
CLIFTON PARK NY
12065-3763
US

IV. Provider business mailing address

130 CANVASS ST
COHOES NY
12047-3049
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-4838
  • Fax:
Mailing address:
  • Phone: 518-235-0827
  • Fax: 518-237-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number152615-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number152615-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number152615-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: