Provider Demographics
NPI:1407833577
Name:YERRAPAREDDY, CHITRAVATHI (MD)
Entity Type:Individual
Prefix:
First Name:CHITRAVATHI
Middle Name:
Last Name:YERRAPAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-833-5700
Mailing Address - Fax:319-833-5740
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-833-5830
Practice Address - Fax:319-833-5831
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34690207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28890OtherWELLMARK HEALTH CARE
IA2263905Medicaid
IA421417307M1OtherJOHNDEERE HEALTH CARE
IAI18807Medicare PIN
IA28890OtherWELLMARK HEALTH CARE