Basic Information
| Provider Information | |||||||||
| NPI: | 1578604583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RESHAMWALA | ||||||||
| FirstName: | PREETI | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64442 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285793 | ||||||||
| FaxNumber: | 4103280248 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 PROSPECT PL SUITE 220 | ||||||||
| Address2: | |||||||||
| City: | CORONADO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921181978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195220399 | ||||||||
| FaxNumber: | 6198694027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2007 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | A116653 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | A116653 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | S062-0309 | 01 | MD | BC/BS REGIONAL | OTHER | 1578604583 | 05 | DE | MEDICAID | 4131321-00 | 05 | MD | MEDICAID | 896886-01 | 01 | MD | BC/BS | OTHER |