Provider Demographics
NPI:1144252438
Name:CELEBRATION OBSTETRICS AND GYNECOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:CELEBRATION OBSTETRICS AND GYNECOLOGY ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-800-0239
Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-566-2229
Mailing Address - Fax:407-566-2499
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 208
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-566-2229
Practice Address - Fax:407-566-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001475400Medicaid
FLK4106Medicare PIN