MEDICARE: DR. KRISTINA REA BLACK KRATOVIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101240416	VA
2	207RB0002X	Obesity Medicine (Internal Medicine) Physician	0101240416	VA

General Provider Information

NPI Number	:	1093881567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA REA BLACK KRATOVIL M.D.

Provider Business Mailing Address
First Line	:	6333 CENTER DR BLDG 16
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4126
Country	:	US
Telephone Number	:	757-252-9500
Fax Number	:	757-962-9801

Provider Business Practice Location Address
First Line	:	6333 CENTER DR BLDG 16
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4126
Country	:	US
Telephone Number	:	757-252-9500
Fax Number	:	757-962-9801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/09/2026

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