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General NPI Number Information
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NPI Number | 1760859409
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Entity Type | Organization
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Legal Business Name | A J CANDELORE DO PLLC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 617 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9714
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Country | US
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Telephone | 207-883-5149
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Fax | 207-883-7885
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Provider Business Mailing Address
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Address Line | 617 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9714
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Country | US
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Telephone | 207-883-5149
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Fax | 207-883-7885
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW J CANDELORE
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Credential | D.O.
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Telephone | 207-883-5149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 880
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License Number State | ME
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