Provider Demographics
NPI:1114266871
Name:THE CELIAC MD INC
Entity Type:Organization
Organization Name:THE CELIAC MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-255-8825
Mailing Address - Street 1:1100 LINCOLN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4900
Mailing Address - Country:US
Mailing Address - Phone:707-927-5622
Mailing Address - Fax:707-927-5747
Practice Address - Street 1:1100 LINCOLN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4900
Practice Address - Country:US
Practice Address - Phone:707-927-5622
Practice Address - Fax:707-927-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty