Healthcare Provider Details

I. General information

NPI: 1043432545
Provider Name (Legal Business Name): TATYANA CHERNOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

IV. Provider business mailing address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-7054
  • Fax: 570-348-7059
Mailing address:
  • Phone: 570-348-7054
  • Fax: 570-348-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD429493
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD429493
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD429493
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberMD429493
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD429493
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: