Provider Demographics
NPI:1992111769
Name:CELEBI CHERUKURI, NIL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NIL
Middle Name:
Last Name:CELEBI CHERUKURI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:NIL
Other - Middle Name:
Other - Last Name:CELEBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1155 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7906
Practice Address - Country:US
Practice Address - Phone:570-808-6113
Practice Address - Fax:570-808-6349
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464781207N00000X
PAMD465566207R00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program