Individual
CANDACE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3914 CENTREVILLE RD STE 101, CHANTILLY, VA 20151-3289
(703) 481-8600
(703) 481-8618
Mailing address
3914 CENTREVILLE RD, CHANTILLY, VA 20151-3289
(703) 481-8600
(855) 308-2338
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101057927
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6714463
—
VA
05
—
6733999
—
VA
Enumeration date
05/03/2006
Last updated
01/22/2020
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