Provider Demographics
NPI:1265497879
Name:RESNICK, STACI M (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:RESNICK
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 1:851 MIDDLE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1778
Mailing Address - Country:US
Mailing Address - Phone:508-324-6800
Mailing Address - Fax:508-674-5440
Practice Address - Street 1:851 MIDDLE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1778
Practice Address - Country:US
Practice Address - Phone:508-324-6800
Practice Address - Fax:508-674-5440
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1563462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG69769Medicare UPIN