Provider Demographics
NPI:1639699796
Name:ZIVAN, TAL (MD)
Entity type:Individual
Prefix:DR
First Name:TAL
Middle Name:
Last Name:ZIVAN
Suffix:
Gender:M
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:PO BOX 8538-227
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-0001
Mailing Address - Country:US
Mailing Address - Phone:484-337-1530
Mailing Address - Fax:
Practice Address - Street 1:1991 SPROUL RD STE 220
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3518
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:610-356-1836
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease