Provider Demographics
NPI:1649269952
Name:CANDELORE, ANDREW J (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:CANDELORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9714
Mailing Address - Country:US
Mailing Address - Phone:207-883-5149
Mailing Address - Fax:207-883-7885
Practice Address - Street 1:617 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9714
Practice Address - Country:US
Practice Address - Phone:207-883-5149
Practice Address - Fax:207-883-7885
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001649OtherANTHEM
ME107490000Medicaid
MED93089OtherHARVARD PILGRIM
ME107490000Medicaid
MED93089Medicare UPIN
ME081132821Medicare PIN