Provider Demographics
NPI:1225337322
Name:CELEBRATION PEDIATRICS LLC
Entity Type:Organization
Organization Name:CELEBRATION PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-566-2229
Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-566-9700
Mailing Address - Fax:
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 206
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-566-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty