Provider Demographics
NPI:1154403632
Name:LAROIA, SANDEEP TIRATH (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:TIRATH
Last Name:LAROIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3859
Mailing Address - Fax:319-356-2220
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3859
Practice Address - Fax:319-356-2220
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9166207R00000X
IA36595207R00000X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70199OtherWELLMARK BCBS
ND6206Medicare ID - Type Unspecified
IAI0923247Medicare PIN
IAP00734617Medicare PIN
IA70199OtherWELLMARK BCBS