Provider Demographics
NPI:1568458818
Name:RESNIK, ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:RESNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16139 LANCASTER HIGHWAY
Mailing Address - Street 2:STE. 140
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-540-6930
Mailing Address - Fax:704-540-4938
Practice Address - Street 1:16139 LANCASTER HIGHWAY
Practice Address - Street 2:#140
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-540-6930
Practice Address - Fax:704-540-4938
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71292OtherBLUE CROSS & BLUE SHIELD
NC7971292Medicaid
NC7971292Medicaid
C81181Medicare UPIN