Provider Demographics
NPI:1316988140
Name:REZNIK, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3801 WAKE FOREST RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-787-7246
Mailing Address - Fax:919-787-7247
Practice Address - Street 1:10880 DURANT RD STE 324
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6629
Practice Address - Country:US
Practice Address - Phone:919-787-7246
Practice Address - Fax:919-787-7247
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-00863208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC152RMOtherBCBSNC
NC59-11943Medicaid
NC2208572OtherMAMSI
NC4256796OtherCIGNA
NC7078808OtherAETNA
NCP00725886OtherRAILROAD MEDICARE
NCP00725886OtherRAILROAD MEDICARE