Provider Demographics
NPI:1659613222
Name:PIZZA, CELESTE P (MD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:P
Last Name:PIZZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5716
Mailing Address - Country:US
Mailing Address - Phone:703-559-4799
Mailing Address - Fax:
Practice Address - Street 1:11728 NANCY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5716
Practice Address - Country:US
Practice Address - Phone:703-559-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266974207R00000X
VA0101271561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA266974OtherMA MEDICAL LICENSE
MAMP1052492AOtherMA CONTROLLED SUBSTANCE
VA0101271561OtherVA MEDICAL LICENSE
VA0101271561OtherVA MEDICAL LICENSE