Healthcare Provider Details

I. General information

NPI: 1538727409
Provider Name (Legal Business Name): SUDHEER KONDURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 445
HAMPTON VA
23666-5981
US

IV. Provider business mailing address

100 SENTARA CIR RM 2C
WILLIAMSBURG VA
23188-5713
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2127
  • Fax: 757-827-2255
Mailing address:
  • Phone: 757-984-7217
  • Fax: 757-984-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101287659
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number333664
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT218178
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: