Healthcare Provider Details

I. General information

NPI: 1245751023
Provider Name (Legal Business Name): ZENOVIA TARMOHAMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date: 02/06/2018
Reactivation Date: 02/13/2018

III. Provider practice location address

1850 EAST PARK AVENUE, SUITE 207 PENN STATE HEALTH AT MOUNT NITTANY MEDICAL CENTER
STATE COLLEGE PA
16803
US

IV. Provider business mailing address

1850 EAST PARK AVENUE, SUITE 207 PENN STATE HEALTH AT MOUNT NITTANY MEDICAL CENTER
STATE COLLEGE PA
16803
US

V. Phone/Fax

Practice location:
  • Phone: 814-235-2480
  • Fax:
Mailing address:
  • Phone: 814-235-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

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: