Provider Demographics
NPI:1033383534
Name:CEREMUGA, COLLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:CEREMUGA
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10400 LITTLE PATUXENT PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3518
Mailing Address - Country:US
Mailing Address - Phone:888-339-8727
Mailing Address - Fax:
Practice Address - Street 1:10400 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3518
Practice Address - Country:US
Practice Address - Phone:888-339-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112399207L00000X
VA01012529772083A0300X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine