Healthcare Provider Details

I. General information

NPI: 1376163147
Provider Name (Legal Business Name): JONIQUA NASHAE CEASAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 MARKET ST
PHILADELPHIA PA
19139-3508
US

IV. Provider business mailing address

423 GUARDIAN DR BLOCKLEY HALL, 1303A
PHILADELPHIA PA
19104-4865
US

V. Phone/Fax

Practice location:
  • Phone: 267-425-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD485978
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82736
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: