Provider Demographics
NPI:1831192145
Name:ZELEN, RANDY S (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:S
Last Name:ZELEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1034 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-3945
Mailing Address - Fax:814-333-3947
Practice Address - Street 1:765 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2567
Practice Address - Country:US
Practice Address - Phone:814-333-3947
Practice Address - Fax:814-333-3947
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031510E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0837652Medicaid
PAE55461OtherHEALTH AMERICA
PA390003680OtherPALMETTO GBA-RAILROAD MEDICARE
PA1530398OtherGATEWAY HEALTH PLAN
PA0009664400003Medicaid
PA205062OtherUPMC HEALTH PLAN
PA902561OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PA205062OtherCIGNA
PA110929OtherUNISON HEALTH PLAN
PA251754199019OtherMEDICAL MUTUAL OF OHIO
OH0837652Medicaid
PA110929OtherUNISON HEALTH PLAN