Provider Demographics
NPI:1265443717
Name:KOLEV, TANIA DIMITROVA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:DIMITROVA
Last Name:KOLEV
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 1:25 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2918
Mailing Address - Country:US
Mailing Address - Phone:717-730-9782
Mailing Address - Fax:717-730-9854
Practice Address - Street 1:25 N 32ND ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2918
Practice Address - Country:US
Practice Address - Phone:717-730-9782
Practice Address - Fax:717-730-9854
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069145L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN