Provider Demographics
NPI:1043573876
Name:PAUL, CEENA PHILIPOSE (MD)
Entity type:Individual
Prefix:
First Name:CEENA
Middle Name:PHILIPOSE
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CEENA
Other - Middle Name:
Other - Last Name:PHILIPOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2302
Mailing Address - Country:US
Mailing Address - Phone:937-484-6157
Mailing Address - Fax:
Practice Address - Street 1:204 PATRICK AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2302
Practice Address - Country:US
Practice Address - Phone:937-484-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics