Provider Demographics
NPI:1013917558
Name:THONDAPU, VANAJA (MD)
Entity Type:Individual
Prefix:
First Name:VANAJA
Middle Name:
Last Name:THONDAPU
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 1:105 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2209
Mailing Address - Country:US
Mailing Address - Phone:319-467-2000
Mailing Address - Fax:319-467-2505
Practice Address - Street 1:105 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-467-2000
Practice Address - Fax:319-467-2505
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF55573Medicare UPIN
IA110106596OtherRAILROAD MEDICARE
IAF55573Medicare UPIN
IA51180OtherBLUE CROSS
IA19613OtherIOWA HEALTH SOLUTIONS
IA51180Medicare PIN