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General NPI Number Information
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NPI Number | 1528359825
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Entity Type | Individual
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Provider Name | CANDICE MARIE MORELAND PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 101 MARCLEY DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-2977
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Country | US
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Telephone | 304-263-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MARCLEY DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-2977
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Country | US
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Telephone | 304-263-8911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0004431
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 01630
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License Number State | WV
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