Provider Demographics
NPI:1639198625
Name:PRETILA, EDNA B (MD)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:B
Last Name:PRETILA
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 1:107 PLUM LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9076
Mailing Address - Country:US
Mailing Address - Phone:812-246-3047
Mailing Address - Fax:
Practice Address - Street 1:647 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2453
Practice Address - Country:US
Practice Address - Phone:812-282-4309
Practice Address - Fax:812-283-8299
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027440A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000207781OtherANTHEM
IN0698592OtherAETNA
IN100221750AMedicaid
IN351282109OtherUNITED HEALTHCARE
IN735240OtherRAILROAD MEDICARE
IN2750654OtherCIGNA
IN351282109OtherUNITED HEALTHCARE
IN0698592OtherAETNA