Provider Demographics
NPI:1710074349
Name:ZELONIS, THOMAS GABRIEL (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GABRIEL
Last Name:ZELONIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HIGBEE DR STE B-104
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2989
Mailing Address - Country:US
Mailing Address - Phone:412-854-7924
Mailing Address - Fax:412-854-7926
Practice Address - Street 1:2403 SOUTH PARK RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-835-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S004375L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74232Medicare UPIN
PAZE507453Medicare ID - Type Unspecified