Provider Demographics
NPI:1447259676
Name:LOBAO, CELSO BENEDITO (MD)
Entity type:Individual
Prefix:DR
First Name:CELSO
Middle Name:BENEDITO
Last Name:LOBAO
Suffix:
Gender:M
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:PO BOX 14067
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620
Mailing Address - Country:US
Mailing Address - Phone:919-250-7246
Mailing Address - Fax:888-259-7335
Practice Address - Street 1:3020 FALSTAFF RD, SUITE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1812
Practice Address - Country:US
Practice Address - Phone:919-250-7246
Practice Address - Fax:888-259-7335
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC354112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952418Medicaid
NC5901686Medicaid
NC2344832Medicare PIN
NC2174325Medicare PIN
NC8952418Medicaid