Provider Demographics
NPI:1144403775
Name:BERESNEV, ANNA S (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:S
Last Name:BERESNEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:315-769-4353
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1037
Practice Address - Country:US
Practice Address - Phone:315-769-4638
Practice Address - Fax:315-842-3099
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266412207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03781826Medicaid
NY03781826Medicaid