Provider Demographics
NPI:1902888613
Name:MOORADIAN, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:MOORADIAN
Suffix:
Gender:M
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:515-288-1097
Mailing Address - Fax:
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-288-1097
Practice Address - Fax:515-288-2847
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-33317208000000X, 2080P0202X
IA333172080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0206342Medicaid
IA0206342Medicaid
IA19401Medicare ID - Type Unspecified