Individual
BORIS REZNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5936 LIMESTONE RD, SUITE 301, HOCKESSIN, DE 19707-8930
(302) 234-5800
(302) 234-2380
Mailing address
5936 LIMESTONE RD, SUITE 301, HOCKESSIN, DE 19707-8930
(302) 234-5800
(302) 234-2380
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
MT193775
PA
2085R0202X
Diagnostic Radiology Physician
Primary
C1-0009120
DE
390200000X
Student in an Organized Health Care Education/Training Program
MT193775
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720242365
RR MEDICARE
DE
05
—
1720242365
—
DE
Enumeration date
07/14/2008
Last updated
02/16/2010
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