Provider Demographics
NPI:1790922441
Name:LOZANO CELIS, MARIA CONSUELO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA CONSUELO
Middle Name:
Last Name:LOZANO CELIS
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:P.O. BOX 1606
Mailing Address - Street 2:
Mailing Address - City:CHADDS
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:515-302-4931
Mailing Address - Fax:859-203-3079
Practice Address - Street 1:36 E FRONT STREET
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:302-268-7477
Practice Address - Fax:859-203-3079
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4411752084P0800X
IA396972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
IA07466OtherWELLMARK BCBS
IA0159608Medicaid