Healthcare Provider Details

I. General information

NPI: 1477738110
Provider Name (Legal Business Name): TALIA ZENLEA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST 3RD FLOOR
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

146 W RIVER ST 3RD FLOOR
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5700
  • Fax: 401-793-7801
Mailing address:
  • Phone: 401-793-5700
  • Fax: 401-793-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD14289
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14289
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: