Provider Demographics
NPI:1528053840
Name:REGANTI, ROHINI (MD)
Entity type:Individual
Prefix:
First Name:ROHINI
Middle Name:
Last Name:REGANTI
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 1:1225 S GEAR AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-753-1220
Mailing Address - Fax:319-753-5464
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-753-1220
Practice Address - Fax:319-753-5464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23028207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08895OtherBCBS OF IA PROVIDER NUMBE
IA1213009Medicaid
IAI0874Medicare ID - Type UnspecifiedPROVIDER NUMBER
IA1213009Medicaid