MEDICARE: DR. TATYANA PANKRATOVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	MD448702	PA
2	207R00000X	Internal Medicine Physician	57.017371	OH
3	207R00000X	Internal Medicine Physician	MD176264	OR
4	207R00000X	Internal Medicine Physician	25253	WV
5	207R00000X	Internal Medicine Physician	MD448702	PA
6	208M00000X	Hospitalist Physician	ME170809	FL

General Provider Information

NPI Number	:	1013216324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA PANKRATOVA M.D.

Provider Business Mailing Address
First Line	:	1460 G ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4112
Country	:	US
Telephone Number	:	541-744-8613
Fax Number	:	541-744-8608

Provider Business Practice Location Address
First Line	:	2128 BLAKESLEE BOULEVARD DR E
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-9619
Country	:	US
Telephone Number	:	610-402-5369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	10/18/2024

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