Individual
CANDACE C CHIDESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1840 LOCUST AVE, FAIRMONT, WV 26554
(304) 366-6907
(304) 366-6216
Mailing address
1840 LOCUST AVE, FAIRMONT, WV 26554
(304) 366-6907
(304) 366-6216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12467
WV
208D00000X
General Practice Physician
12467
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721214
BC
WV
05
—
0050726000
—
WV
Enumeration date
12/12/2006
Last updated
02/23/2011
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