=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881876266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELESTE CHERYLL LOPEZ QUIANZON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 07/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 FAIRVIEW AVE STE 335
-----------------------------------------------------
City | SKOWHEGAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04976-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-858-8216
-----------------------------------------------------
Fax | 207-474-8089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 468
-----------------------------------------------------
City | SKOWHEGAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04976-0468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-858-8216
-----------------------------------------------------
Fax | 207-474-8089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD19185
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD19185
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------