Provider Demographics
NPI:1447260344
Name:TSANG, CELINA C (MD)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:C
Last Name:TSANG
Suffix:
Gender:F
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 500
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-0500
Mailing Address - Country:US
Mailing Address - Phone:217-670-2424
Mailing Address - Fax:217-670-2809
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-698-9722
Practice Address - Fax:217-391-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082850Medicaid
IL055218OtherHEALTH ALLIANCE
IL110140985OtherRR MEDICARE PIN
IL6394POtherCATERPILLAR
ILCD7143OtherRR MEDICARE GROUP
IL020057300OtherBLACK LUNG
IL170771OtherPERSONAL CARE
IL133586700OtherACS-OWCP
IL142113OtherHEALTHLINK
IL14D0949277OtherCLIA
IL036082850OtherIL STATE LICENSE
IL08421024OtherBC/BS
IL170771OtherPERSONAL CARE