Provider Demographics
NPI:1578604583
Name:RESHAMWALA, PREETI A (MD)
Entity Type:Individual
Prefix:DR
First Name:PREETI
Middle Name:A
Last Name:RESHAMWALA
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-5793
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:230 PROSPECT PL SUITE 220
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1978
Practice Address - Country:US
Practice Address - Phone:619-522-0399
Practice Address - Fax:619-869-4027
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA116653207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0309OtherBC/BS REGIONAL
DE1578604583Medicaid
MD4131321-00Medicaid
MD896886-01OtherBC/BS
MDP00439439Medicare PIN
MDS062-0309OtherBC/BS REGIONAL