Healthcare Provider Details

I. General information

NPI: 1245223601
Provider Name (Legal Business Name): CANDACE ROWLAND PATE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7023 OLD JAHNKE RD
RICHMOND VA
23225
US

IV. Provider business mailing address

7023 OLD JAHNKE RD
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-1353
  • Fax: 804-320-6636
Mailing address:
  • Phone: 804-320-1353
  • Fax: 804-320-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101054279
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101054279
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: