Basic Information
| Provider Information | |||||||||
| NPI: | 1477904589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANGULA | ||||||||
| FirstName: | PRIYADARSHINI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152394418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152396992 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 45817 | IA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.