Provider Demographics
NPI:1902242050
Name:WIDUCH-MERT, CANDICE (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WIDUCH-MERT
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 1:18 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-1602
Mailing Address - Country:US
Mailing Address - Phone:814-342-2333
Mailing Address - Fax:814-254-4733
Practice Address - Street 1:1481 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3217
Practice Address - Country:US
Practice Address - Phone:814-298-7428
Practice Address - Fax:814-536-1044
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT203563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD458967OtherPA MEDICAL LICENSE