Etny R Candelario, MD
Family Medicine in Mystic, Connecticut
1568084150- Practice location
- 100 Perkins Farm Dr Ste 203, Mystic, CT 06355-4041
- Phone
- 860-576-8911
- Fax
- 860-572-7758
- Last updated
- August 23, 2024
Etny Raul Candelario is a Family Medicine based in Mystic, CT. Etny Raul Candelario practices in Mystic, CT and has the professional credentials of MD. The NPI Number for Etny Raul Candelario is 1568084150 and holds a License No. 4301510053 (MI). The current practice location address for Etny Raul Candelario is 100 Perkins Farm Dr Ste 203, Mystic, CT 06355-4041 and can be reached out via phone at 860-576-8911 and via fax at 860-572-7758.
Provider Profile Details
- NPI Number
- 1568084150
- Provider Name
- Etny Raul Candelario
- Credential
- MD
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 100 Perkins Farm Dr Ste 203, Mystic, CT 06355-4041
- Phone Number
- 860-576-8911
- Fax Number
- 860-572-7758
- Primary Taxonomy
- Family Medicine · 207Q00000X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- May 18, 2020
- Last Update Date
- August 23, 2024
- Certification Date
- August 23, 2024
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 100 Perkins Farm Dr Ste 203
Mystic, CT 06355-4041 - City
- Mystic
- State
- Connecticut
- Zip
- 06355-4041
- Phone Number
- 860-576-8911
- Fax Number
- 860-572-7758
Provider Business Mailing Address Details
- Address
- 1339 Fair Ave
San Antonio, TX 78223-1437 - City
- San Antonio
- State
- TX
- Zip
- 78223-1437
- Phone Number
- 210-923-4372
- Fax Number
- 210-923-5581
License Information
- License Number (1)
- 4301510053
- License State (1)
- MI
- Taxonomy (1)
- Family Medicine · 207Q00000X
- License Number (2)
- U6458
- License State (2)
- TX
- Taxonomy (2)
- Family Medicine · 207Q00000X
- License Number (3)
- 79070
- License State (3)
- CT
- Taxonomy (3)
- Family Medicine · 207Q00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Etny R Candelario, MD?
The NPI number of Etny R Candelario, MD is 1568084150. It was assigned on May 18, 2020 and is currently active in the NPPES registry.
What is the specialty of Etny R Candelario, MD?
Etny R Candelario, MD is registered under the primary taxonomy Family Medicine (code 207Q00000X), licensed in MI under license number 4301510053.
Where does Etny R Candelario, MD practice?
The practice location is 100 Perkins Farm Dr Ste 203, Mystic, CT 06355-4041. The office can be reached at 860-576-8911 (phone) or 860-572-7758 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1568084150 directly on the NPPES registry website.