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NPI Code Detail

MEDICARE: DR. KRISHNA RAO KUDARAVALLI M.D

MEDICARE: DR. KRISHNA RAO KUDARAVALLI 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
1207V00000XObstetrics & Gynecology Physician0101033170VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104810142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISHNA RAO KUDARAVALLI M.D
Provider Business Mailing Address
First Line : 436 CLAIRMONT CT STE 105
Second Line :
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-1765
Country : US
Telephone Number : 804-765-5206
Fax Number : 804-765-5809
Provider Business Practice Location Address
First Line : 210 MEDICAL PARK BOULEVARD
Second Line : SUITE 150
City : PETERSBURG
State : VA
Zip : 23805-9274
Country : US
Telephone Number : 804-765-5206
Fax Number : 804-765-5809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 01/19/2018

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