=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144371824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDICE P. HOLDEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25055 RIDING PLZ STE 260
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20152-5922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-272-5000
-----------------------------------------------------
Fax | 703-957-3804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21475 RIDGETOP CIR STE 150
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20166-6580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-444-5000
-----------------------------------------------------
Fax | 703-444-4999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | C10007584
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MA07484000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD419362
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MA07484000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101258624
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------