Provider Demographics
NPI:1871592436
Name:CELIO, LEE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANTHONY
Last Name:CELIO
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 1:2701 HOLME AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-2700
Mailing Address - Fax:
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2014-01-22
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
PAMD029747E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01082270Medicaid
PA01082270Medicaid
PA118630FMCMedicare ID - Type Unspecified