Provider Demographics
NPI:1487883419
Name:PHILIP, CELESTE M (MD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:M
Last Name:PHILIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 HOLSONBACK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5114
Mailing Address - Country:US
Mailing Address - Phone:386-274-0627
Mailing Address - Fax:386-274-0840
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5114
Practice Address - Country:US
Practice Address - Phone:386-274-0627
Practice Address - Fax:386-274-0840
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME92957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000991300Medicaid
FLCU416ZMedicare PIN