=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770582876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE L DYER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 TOLL GATE RD STE.200
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-739-8010
-----------------------------------------------------
Fax | 401-739-6087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 TOLL GATE RD STE 200
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-739-8010
-----------------------------------------------------
Fax | 401-739-6087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | RI6126
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------