Provider Demographics
NPI:1063094928
Name:LICANDRO, FRANCESCA (MD)
Entity type:Individual
Prefix:
First Name:FRANCESCA
Middle Name:
Last Name:LICANDRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVENUE
Mailing Address - Street 2:MEDICAL EDUCATION OFFICE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-7649
Mailing Address - Fax:410-601-7649
Practice Address - Street 1:185 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-06-15
Deactivation Date:2022-03-02
Deactivation Code:
Reactivation Date:2022-06-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program