Healthcare Provider Details

I. General information

NPI: 1831192145
Provider Name (Legal Business Name): RANDY S ZELEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 LIBERTY STREET
MEADVILLE PA
16335-2567
US

IV. Provider business mailing address

1034 GROVE STREET
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-3947
  • Fax: 814-333-3947
Mailing address:
  • Phone: 814-333-3945
  • Fax: 814-333-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD031510E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: