Provider Demographics
NPI:1598870586
Name:RADIA, MARY A (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:RADIA
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 1:8421 PLUM DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7356
Mailing Address - Country:US
Mailing Address - Phone:515-270-7222
Mailing Address - Fax:515-270-7202
Practice Address - Street 1:8421 PLUM DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-7356
Practice Address - Country:US
Practice Address - Phone:515-643-9699
Practice Address - Fax:515-643-9698
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01959207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5030650Medicaid
IAA03182Medicare UPIN
IAI9391Medicare ID - Type Unspecified