Provider Demographics
NPI:1982299921
Name:CHANG, CELINE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:CELINE
Other - Middle Name:
Other - Last Name:PASCUAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1308 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR STE P1
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:443-492-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD766383800Medicaid