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Individual
CANDICE BLACK
Active
Individual
CANDICE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
11684
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009038
—
VT
05
—
30222118
—
NH
Enumeration date
07/12/2006
Last updated
07/16/2007
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