Provider Demographics
NPI:1265609234
Name:TRIPATHY, ASIT KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ASIT
Middle Name:KUMAR
Last Name:TRIPATHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST., STE. 116
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1453
Mailing Address - Country:US
Mailing Address - Phone:515-241-6544
Mailing Address - Fax:515-241-6533
Practice Address - Street 1:1215 PLEASANT ST., STE. 116
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1453
Practice Address - Country:US
Practice Address - Phone:515-241-6544
Practice Address - Fax:515-241-6533
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38345208000000X, 2084N0402X
OH57-0113862084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1720073083Medicaid
IA1720073083Medicaid