Individual provider Active NPI

Tracey L. Zellner, M.D.

  • Pediatrics Physician
  • State College, PA
National Provider Identifier
1164486635
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD065986L Issued in PA
Practice address
3901 S Atherton St
Suite 5
State College, PA 16801-8324
Phone
(814) 466-7921
Fax
(814) 466-6570
NPI assigned
Apr 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD065986L PA Primary

Addresses

Primary practice location

3901 S Atherton St
Suite 5
State College, PA 16801-8324

Mailing address

3901 S Atherton St
Suite 5
State College, PA 16801-8324
Phone (814) 466-7921

Other names 1

  • Tracey L Trudel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100813000256 PA Practitioner - Pediatric Medicine 8224162185 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Nittany Medical Center Health Services Inc Pediatrics CurrentSince Jan 1, 2011 Accepting new patients
Mount Nittany Medical Center Health Services Inc PastSince Jan 1, 2011 Accepting new patients

Locations

129 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-2762

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

3901 S Atherton St
Ste 5
State College, PA 16801
Phone (814) 466-7921

3901 S Atherton St
#5
State College, PA 16801

143 Hospital Dr
Ste 301
State College, PA 16803
Phone (814) 231-6862

164 Greenview Dr
Ste 145
State College, PA 16803

1850 E Park Ave
#201
State College, PA 16803
Phone (814) 234-8800

3901 S Atherton St
Ste 100
State College, PA 16801

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1164486635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 S ATHERTON ST",
            "address_2": "SUITE 5",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168018324",
            "telephone_number": "814-466-7921",
            "fax_number": "814-466-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 S ATHERTON ST",
            "address_2": "SUITE 5",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168018324",
            "telephone_number": "814-466-7921",
            "fax_number": "814-466-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELLNER",
        "first_name": "TRACEY",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-13",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD065986L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "TRUDEL",
            "middle_name": "L",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.