Provider Demographics
NPI:1144217712
Name:RESTA, REGINA (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:RESTA
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 1:258 HOOSICK STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2450
Mailing Address - Country:US
Mailing Address - Phone:518-272-2097
Mailing Address - Fax:518-272-6612
Practice Address - Street 1:258 HOOSICK STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2450
Practice Address - Country:US
Practice Address - Phone:518-272-2097
Practice Address - Fax:518-272-6612
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209082207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1T70485471Medicare PIN
900003633Medicare PIN
900003639Medicare PIN
IT7043Medicare PIN
E91462Medicare UPIN
CC5028Medicare PIN