Provider Demographics
NPI:1487944187
Name:REZNICK, STEPHANIE C (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:REZNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 WEST ASH LANE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:330-421-1701
Mailing Address - Fax:
Practice Address - Street 1:3960 WEST ASH LANE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:330-421-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9845207R00000X
TN58511207R00000X
FLME144018207R00000X
OH35-122261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106677Medicaid