Healthcare Provider Details

I. General information

NPI: 1265427603
Provider Name (Legal Business Name): ANTHONY JAMES CANDELLA JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 SOUTHERN BLVD
YOUNGSTOWN OH
44512-5633
US

IV. Provider business mailing address

7630 SOUTHERN BLVD
YOUNGSTOWN OH
44512-5633
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8000
  • Fax: 330-729-8084
Mailing address:
  • Phone: 330-729-8000
  • Fax: 330-729-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34004225C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: