Provider Demographics
NPI:1144631367
Name:BREM, CANDICE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELIZABETH
Last Name:BREM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:609 ALBANY STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2515
Practice Address - Country:US
Practice Address - Phone:617-638-5566
Practice Address - Fax:617-638-5575
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA273953207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3133637Medicaid
MA110134950AMedicaid