Healthcare Provider Details

I. General information

NPI: 1770781353
Provider Name (Legal Business Name): PREETI REBECCA JOHN M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH GREENE STREET BALTIMORE VA MEDICAL CENTER, 5C-125 (SURGERY)
BALTIMORE MD
21201
US

IV. Provider business mailing address

2515 BOSTON ST # 306
BALTIMORE MD
21224-4739
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7233
  • Fax: 410-605-7919
Mailing address:
  • Phone: 973-735-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0067254
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0067254
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberD0067254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: