Provider Demographics
NPI:1457365363
Name:CANDOW, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CANDOW
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 1:1050 MAIN ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3161
Mailing Address - Country:US
Mailing Address - Phone:401-886-9669
Mailing Address - Fax:401-886-9779
Practice Address - Street 1:1050 MAIN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3161
Practice Address - Country:US
Practice Address - Phone:401-886-9669
Practice Address - Fax:401-886-9779
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11488207Q00000X
CT038942207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001389429Medicaid
RI7006186Medicaid
CT010038942CT04OtherANTHEM BCBS
CT010038942CT04OtherANTHEM BCBS
CT010038942CT04OtherANTHEM BCBS
CT001389429Medicaid
CTBC6926589OtherDEA #