Organization
PAIN TREATMENT CENTERS OF MARYLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA REZNIKOV MD (MBR)
(410) 833-1101
Entity
Organization
Contact information
Practice address
116 WESTMINSTER PIKE, SUITE 106, REISTERSTOWN, MD 21136-1027
(410) 833-1011
(410) 833-1680
Mailing address
116 WESTMINSTER PIKE, SUITE 106, REISTERSTOWN, MD 21136-1027
(410) 833-1011
(410) 833-1680
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130198
MEDICARE PTAN
MD
05
—
512314300
—
MD
Enumeration date
03/22/2015
Last updated
01/29/2016
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