1992761456 NPI number — DR. CELERINA MARY JOYCE LIWAG MD

Table of content: DR. CELERINA MARY JOYCE LIWAG MD (NPI 1992761456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992761456 NPI number — DR. CELERINA MARY JOYCE LIWAG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIWAG
Provider First Name:
CELERINA
Provider Middle Name:
MARY JOYCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIWAG
Provider Other First Name:
CELERINA
Provider Other Middle Name:
MARY JOYCE PUGEDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992761456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 NORTH READING RD
Provider Second Line Business Mailing Address:
BACA PEDIATRICS
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17522-1671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-733-0790
Provider Business Mailing Address Fax Number:
717-733-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 NORTH READING RD
Provider Second Line Business Practice Location Address:
BACA PEDIATRICS
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-733-0790
Provider Business Practice Location Address Fax Number:
717-733-1802
Provider Enumeration Date:
04/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD417725 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018947580002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50038237 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".