Provider Demographics
NPI:1811309107
Name:MADHOO REYNOLDS, NATASHA LARA (MD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LARA
Last Name:MADHOO REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:LARA
Other - Last Name:MADHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3462
Mailing Address - Fax:319-356-7899
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3462
Practice Address - Fax:319-356-7899
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-09940208000000X
IAMD-44400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics