Provider Demographics
NPI:1770781353
Name:JOHN, PREETI REBECCA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:PREETI
Middle Name:REBECCA
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2515 BOSTON ST
Mailing Address - Street 2:# 306
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4739
Mailing Address - Country:US
Mailing Address - Phone:973-735-3212
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH GREENE STREET
Practice Address - Street 2:BALTIMORE VA MEDICAL CENTER, 5C-125 (SURGERY)
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-605-7233
Practice Address - Fax:410-605-7919
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067254208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP16125Medicare UPIN