1831192145 NPI number — DR. RANDY S ZELEN M.D.

Table of content: DR. RANDY S ZELEN M.D. (NPI 1831192145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192145 NPI number — DR. RANDY S ZELEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZELEN
Provider First Name:
RANDY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831192145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 GROVE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16335-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-333-3945
Provider Business Mailing Address Fax Number:
814-333-3947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 LIBERTY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16335-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-333-3947
Provider Business Practice Location Address Fax Number:
814-333-3947
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD031510E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0837652 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: E55461 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390003680 . This is a "PALMETTO GBA-RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1530398 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009664400003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205062 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 902561 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 251754199019 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 205062 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 110929 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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