Healthcare Provider Details

I. General information

NPI: 1578604583
Provider Name (Legal Business Name): PREETI A. RESHAMWALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL SUITE 220
CORONADO CA
92118-1978
US

IV. Provider business mailing address

PO BOX 64442
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-0399
  • Fax: 619-869-4027
Mailing address:
  • Phone: 410-328-5793
  • Fax: 410-328-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA116653
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA116653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: