Provider Demographics
NPI:1679695985
Name:ZEIDAN, TRISHA L (MD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:ZEIDAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 GATEKEEPER WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3954
Mailing Address - Country:US
Mailing Address - Phone:614-832-2688
Mailing Address - Fax:
Practice Address - Street 1:5250 FAR HILLS AVE STE 150
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2389
Practice Address - Country:US
Practice Address - Phone:937-356-9966
Practice Address - Fax:937-504-5094
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088287207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2970898Medicaid
OH2970898Medicaid
OH4265631Medicare PIN