Provider Demographics
NPI:1508844416
Name:CELESTE, RON (MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:CELESTE
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 1:9297 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6405
Mailing Address - Country:US
Mailing Address - Phone:440-974-1749
Mailing Address - Fax:
Practice Address - Street 1:7901 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2828
Practice Address - Country:US
Practice Address - Phone:216-961-8100
Practice Address - Fax:216-961-7883
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066648C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000376532OtherANTHEM BCBS
OH0100956Medicaid
OHF93111Medicare UPIN
OH0100956Medicaid