Healthcare Provider Details

I. General information

NPI: 1992761456
Provider Name (Legal Business Name): CELERINA MARY JOYCE LIWAG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELERINA MARY JOYCE PUGEDA LIWAG MD

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 NORTH READING RD BACA PEDIATRICS
EPHRATA PA
17522-1671
US

IV. Provider business mailing address

159 NORTH READING RD BACA PEDIATRICS
EPHRATA PA
17522-1671
US

V. Phone/Fax

Practice location:
  • Phone: 717-733-0790
  • Fax: 717-733-1802
Mailing address:
  • Phone: 717-733-0790
  • Fax: 717-733-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD417725
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018947580002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier50038237
Identifier TypeOTHER
Identifier State
Identifier IssuerCAPITAL BLUE CROSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: