Provider Demographics
NPI:1487710893
Name:RESNICK, MATTHEW JASON (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JASON
Last Name:RESNICK
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:VANDERBILT DEPARTMENT OF UROLOGIC SURGERY
Mailing Address - Street 2:A-1302 MEDICAL CENTER NORTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-322-2101
Mailing Address - Fax:
Practice Address - Street 1:VANDERBILT DEPARTMENT OF UROLOGIC SURGERY
Practice Address - Street 2:A-1302 MEDICAL CENTER NORTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188369208800000X
PAMD439992208800000X
TNMD47049208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology