Provider Demographics
NPI:1043432545
Name:CHERNOVA, TATYANA (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:CHERNOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1624
Mailing Address - Country:US
Mailing Address - Phone:570-348-7054
Mailing Address - Fax:570-348-7059
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-348-7054
Practice Address - Fax:570-348-7059
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429493207ZC0500X, 207ZD0900X, 207ZH0000X, 207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology