Provider Demographics
NPI:1144305012
Name:RESNICK, BRIAN M (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:RESNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1108
Mailing Address - Country:US
Mailing Address - Phone:215-723-7300
Mailing Address - Fax:215-723-8022
Practice Address - Street 1:706 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1108
Practice Address - Country:US
Practice Address - Phone:215-723-7300
Practice Address - Fax:215-723-8022
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008558L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005427547OtherAETNA
G87251Medicare UPIN