Provider Demographics
NPI:1275027963
Name:GANAPATHIRAJU, IASWARYA (DO)
Entity Type:Individual
Prefix:DR
First Name:IASWARYA
Middle Name:
Last Name:GANAPATHIRAJU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3198
Mailing Address - Country:US
Mailing Address - Phone:515-241-5995
Mailing Address - Fax:
Practice Address - Street 1:1415 WOODLAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3203
Practice Address - Country:US
Practice Address - Phone:515-241-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR11266207R00000X
390200000X
NC2023-02589207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program