Provider Demographics
NPI:1154362572
Name:CELESTINE ALIPUI VAN LARE MD PA
Entity type:Organization
Organization Name:CELESTINE ALIPUI VAN LARE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIPUI VAN LARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-450-2040
Mailing Address - Street 1:3611 WALNUT FOREST LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4503
Mailing Address - Country:US
Mailing Address - Phone:281-450-2040
Mailing Address - Fax:281-288-3781
Practice Address - Street 1:3611 WALNUT FOREST LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4503
Practice Address - Country:US
Practice Address - Phone:281-450-2040
Practice Address - Fax:281-288-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097LPOtherBLUE CROSS BLUE SHIELD
TX1751091-01Medicaid
TX00132XMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX1751091-01Medicaid