Provider Demographics
NPI:1104804558
Name:SCHMALBACH, CECELIA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:ELIZABETH
Last Name:SCHMALBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3663
Mailing Address - Fax:215-707-6417
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-3663
Practice Address - Fax:215-707-6417
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075632A207Y00000X
AL32596207Y00000X
PAMD465783207Y00000X
MI4301072453207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201308290Medicaid
IN201308290Medicaid