Basic Information
| Provider Information | |||||||||
| NPI: | 1639799653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOREHART | ||||||||
| FirstName: | CANDICE | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VOLNEY | ||||||||
| OtherFirstName: | CANDICE | ||||||||
| OtherMiddleName: | RAE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 155 FIFTH ST NE | ||||||||
| Address2: | SUMMA HEALTH/ FAMILY RESIDENCY | ||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306153205 | ||||||||
| FaxNumber: | 3307616469 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 FIFTH ST NE | ||||||||
| Address2: | SUMMA HEALTH/ FAMILY RESIDENCY | ||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306153205 | ||||||||
| FaxNumber: | 3307616469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.