Healthcare Provider Details

I. General information

NPI: 1821380023
Provider Name (Legal Business Name): DAVID MEIR REZNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE STE 200
MENTOR OH
44060-8702
US

IV. Provider business mailing address

2300 OVERLOOK RD APT. 716
CLEVELAND HEIGHTS OH
44106-5950
US

V. Phone/Fax

Practice location:
  • Phone: 440-354-0377
  • Fax: 440-354-9368
Mailing address:
  • Phone: 412-580-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.131262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: