Provider Demographics
NPI:1063422012
Name:RAZNICK, DAVID J (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:RAZNICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:JOEL
Other - Last Name:RAZNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:101
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-549-5181
Mailing Address - Fax:410-549-5182
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-549-5181
Practice Address - Fax:410-549-5182
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD649141300Medicaid
MD669L285DMedicare ID - Type Unspecified