Provider Demographics
NPI:1316915895
Name:CARANDANG, REYNALDO A (MD)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:A
Last Name:CARANDANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1340
Mailing Address - Country:US
Mailing Address - Phone:812-885-0881
Mailing Address - Fax:812-885-0886
Practice Address - Street 1:406 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1340
Practice Address - Country:US
Practice Address - Phone:812-885-0881
Practice Address - Fax:812-885-0886
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039560A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008010AMedicaid
IN110044390Medicare PIN
IN200008010AMedicaid
IN258190KKMedicare PIN
IN94114008Medicare PIN
INE96923Medicare UPIN
IN441910EMedicare ID - Type Unspecified
IN441910Medicare PIN