1659961100 NPI number — MRS. CELESTE PEARL DELANA MARSH

Table of content: MRS. CELESTE PEARL DELANA MARSH (NPI 1659961100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659961100 NPI number — MRS. CELESTE PEARL DELANA MARSH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSH
Provider First Name:
CELESTE
Provider Middle Name:
PEARL DELANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659961100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3877 GILBERT STATION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBOURSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22923-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-625-5903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4916 PLANK RD UPPR SUITE6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH GARDEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22959-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-989-9360
Provider Business Practice Location Address Fax Number:
804-716-7186
Provider Enumeration Date:
01/19/2021

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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