Provider Demographics
NPI:1750402681
Name:REZNICHENKO, ALEKSANDR A (MD)
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:A
Last Name:REZNICHENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5506
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:125 W HAGUE RD STE 170
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5811
Practice Address - Country:US
Practice Address - Phone:915-271-4596
Practice Address - Fax:915-271-4597
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2018-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA100964208600000X
NY242179-1208600000X
OH35125461208600000X
TXM4472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery