Healthcare Provider Details

I. General information

NPI: 1154377000
Provider Name (Legal Business Name): NINA TATEVIAN MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/05/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST PATHOLOGY DEPARTMENT
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7655
  • Fax:
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD10517
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMD10517
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: