Provider Demographics
NPI:1700812401
Name:MRUK, CELESTE C (MD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:C
Last Name:MRUK
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 1:2 BALA PLAZA
Mailing Address - Street 2:SUITE 1L-27
Mailing Address - City:BALA CYNWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-668-9999
Mailing Address - Fax:610-668-7188
Practice Address - Street 1:2 BALA PLAZA
Practice Address - Street 2:SUITE 1L-27
Practice Address - City:BALA CYNWOOD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-668-9999
Practice Address - Fax:610-668-7188
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020996E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008760110008Medicaid
D70026Medicare UPIN
PA0008760110008Medicaid