Provider Demographics
NPI:1639219439
Name:ZELENSKA, TETYANA A (MD)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:A
Last Name:ZELENSKA
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 1:63 EASTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1610
Mailing Address - Country:US
Mailing Address - Phone:610-296-2760
Mailing Address - Fax:
Practice Address - Street 1:63 EASTWOOD RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1610
Practice Address - Country:US
Practice Address - Phone:610-296-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA430613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine