Provider Demographics
NPI:1497860365
Name:CHATURVEDI, PRETI BALA (MD)
Entity Type:Individual
Prefix:
First Name:PRETI
Middle Name:BALA
Last Name:CHATURVEDI
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 1:1 PARK WEST BLVD
Mailing Address - Street 2:STE 270
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4231
Mailing Address - Country:US
Mailing Address - Phone:330-344-6072
Mailing Address - Fax:330-344-6447
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-6072
Practice Address - Fax:330-344-6447
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH080842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000328462OtherANTHEM
OH2490817Medicaid
OHI02951Medicare UPIN
OH000000328462OtherANTHEM