MEDICARE: DR. RANDY S ZELEN M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	MD031510E	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	390003680	OTHER	PA	PALMETTO GBA-RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	E55461	OTHER	PA	HEALTH AMERICA
4	1530398	OTHER	PA	GATEWAY HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	205062	OTHER	PA	UPMC HEALTH PLAN
7	902561	OTHER	PA	HIGHMARK BLUE CROSS BLUE SHIELD
8	251754199019	OTHER	PA	MEDICAL MUTUAL OF OHIO
9	205062	OTHER	PA	CIGNA
10	110929	OTHER	PA	UNISON HEALTH PLAN

NPI Number	:	1831192145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY S ZELEN M.D.

Provider Business Mailing Address
First Line	:	1034 GROVE STREET
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2945
Country	:	US
Telephone Number	:	814-333-3945
Fax Number	:	814-333-3947

Provider Business Practice Location Address
First Line	:	765 LIBERTY STREET
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2567
Country	:	US
Telephone Number	:	814-333-3947
Fax Number	:	814-333-3947

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/17/2016