MEDICARE: DR. TATYANA REZNIKOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	D0066080	MD
2	204R00000X	Electrodiagnostic Medicine Physician	D0066080	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	130198	OTHER	MD	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982819421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA REZNIKOV MD

Provider Business Mailing Address
First Line	:	116 WESTMINSTER PIKE
Second Line	:	SUITE 106
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1027
Country	:	US
Telephone Number	:	410-833-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 WESTMINSTER PIKE
Second Line	:	SUITE 106
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1027
Country	:	US
Telephone Number	:	410-833-1011
Fax Number	:	410-833-1705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	01/18/2017

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