MEDICARE: CANDINA RANEE MCCULLOUGH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	25595	WV
2	207V00000X	Obstetrics & Gynecology Physician	35-097575	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730371295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDINA RANEE MCCULLOUGH M.D.

Provider Business Mailing Address
First Line	:	2000 MON HEALTH MEDICAL PARK DR STE 2100
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1134
Country	:	US
Telephone Number	:	304-599-6811
Fax Number	:	304-599-7159

Provider Business Practice Location Address
First Line	:	2000 MON HEALTH MEDICAL PARK DR STE 2100
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505
Country	:	US
Telephone Number	:	304-599-6811
Fax Number	:	304-599-7159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	03/25/2026

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