Provider Demographics
NPI:1144373549
Name:MENCHAVEZ, CELESTINO MONZON (MD)
Entity type:Individual
Prefix:DR
First Name:CELESTINO
Middle Name:MONZON
Last Name:MENCHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1850
Mailing Address - Country:US
Mailing Address - Phone:301-777-2722
Mailing Address - Fax:301-777-2736
Practice Address - Street 1:915 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1850
Practice Address - Country:US
Practice Address - Phone:301-777-2722
Practice Address - Fax:301-777-2736
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402692600Medicaid