Provider Demographics
NPI:1487753232
Name:TIDRIRI, VIRGINIA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:LEE
Last Name:TIDRIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:GEARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 IOWA AVE W
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4768
Mailing Address - Country:US
Mailing Address - Phone:641-754-6715
Mailing Address - Fax:641-753-1375
Practice Address - Street 1:101 IOWA AVE W
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4768
Practice Address - Country:US
Practice Address - Phone:641-754-6700
Practice Address - Fax:641-753-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22487OtherLICENSE
IA22487OtherLICENSE