MEDICARE: DR. CHARLES N CELANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME 50599	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174573794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES N CELANO MD

Provider Business Mailing Address
First Line	:	3607 15TH AVE
Second Line	:	STE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6513
Country	:	US
Telephone Number	:	772-562-8522
Fax Number	:	772-562-0317

Provider Business Practice Location Address
First Line	:	3607 15TH AVE
Second Line	:	STE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6513
Country	:	US
Telephone Number	:	772-562-8522
Fax Number	:	772-562-0317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/10/2011

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