Provider Demographics
NPI:1336503259
Name:DENISKIN, ROMAN (MD, PHD, MSC)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:DENISKIN
Suffix:
Gender:M
Credentials:MD, PHD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 ASHFORD BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5179
Mailing Address - Country:US
Mailing Address - Phone:818-621-1782
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:STE K201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-218-2509
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY548852080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program