Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103000387 | VA |
Y | 222Z00000X | Podiatrist | 0103000387 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103000387 | VA |
N | 111NR0200X | Radiology | 0103000387 | VA |
N | 213ER0200X | Radiology | 0103000387 | VA |
N | 2081S0010X | Sports Medicine | 0103000387 | VA |
N | 213ES0000X | Sports Medicine | 0103000387 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 0103000387 | VA |
NPI | 1548268972 |
---|---|
Provider Name | Dr. Richard Resnick |
First Address | Burke, VA 22015-1604 |
Second Address | Burke, VA 22015-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 27/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0866 | CARE FIRST (01) | VA |
T22972 | (02) | VA |