Individual
DR. TATYANA REZNIKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
116 WESTMINSTER PIKE, SUITE 106, REISTERSTOWN, MD 21136-1027
(410) 833-1011
(410) 833-1705
Mailing address
116 WESTMINSTER PIKE, SUITE 106, REISTERSTOWN, MD 21136-1027
(410) 833-1011
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
D0066080
MD
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
D0066080
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130198
MEDICARE PTAN
MD
05
—
512314300
—
MD
Enumeration date
05/10/2007
Last updated
01/18/2017
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