Healthcare Provider Details

I. General information

NPI: 1750909404
Provider Name (Legal Business Name): CELINE RICHARD M.D. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST # G10
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

PEDIATRIC ENT DEPARTMENT, NATIONWIDE CHILDREN'S HOSPITA 700 CHILDREN'S DR.
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax:
Mailing address:
  • Phone: 614-737-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number65584
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number57.248750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: