Provider Demographics
NPI:1982663316
Name:CELADA, MARCO A SR (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:CELADA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:ANTONIO
Other - Last Name:CELADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-0639
Mailing Address - Country:US
Mailing Address - Phone:719-274-5121
Mailing Address - Fax:719-274-6003
Practice Address - Street 1:19021 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140
Practice Address - Country:US
Practice Address - Phone:719-274-5121
Practice Address - Fax:719-274-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine