Provider Demographics
NPI:1518944040
Name:RICHARD, CELINE (CNM)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 E CONCORD ST
Mailing Address - Street 2:MAT 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2644
Mailing Address - Country:US
Mailing Address - Phone:617-414-5469
Mailing Address - Fax:617-414-5686
Practice Address - Street 1:91 E CONCORD ST
Practice Address - Street 2:MAT 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2644
Practice Address - Country:US
Practice Address - Phone:617-414-5469
Practice Address - Fax:617-414-5686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225642207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology