Provider Demographics
NPI:1174573794
Name:CELANO, CHARLES N (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:N
Last Name:CELANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3607 15TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6513
Mailing Address - Country:US
Mailing Address - Phone:772-562-8522
Mailing Address - Fax:772-562-0317
Practice Address - Street 1:3607 15TH AVE
Practice Address - Street 2:STE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6513
Practice Address - Country:US
Practice Address - Phone:772-562-8522
Practice Address - Fax:772-562-0317
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 50599207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062571000Medicaid
FL062571000Medicaid