MEDICARE: CANDACY GEORGE D.O.

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	207Q00000X	Family Medicine Physician	5101021466	MI
2	207Q00000X	Family Medicine Physician	25MB10699300	NJ

General Provider Information

NPI Number	:	1841690021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACY GEORGE D.O.

Provider Business Mailing Address
First Line	:	200 HYGEIA DR
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 SHELL RD
Second Line	:
City	:	CARNEYS POINT
State	:	NJ
Zip	:	08069-2743
Country	:	US
Telephone Number	:	856-299-4600
Fax Number	:

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

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	10/10/2019

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