Basic Information
| Provider Information | |||||||||
| NPI: | 1750402681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REZNICHENKO | ||||||||
| FirstName: | ALEKSANDR | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 CENTRAL CREDENTIALING | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135855506 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 W HAGUE RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152714596 | ||||||||
| FaxNumber: | 9152714597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A100964 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 242179-1 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35125461 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | M4472 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.