Healthcare Provider Details

I. General information

NPI: 1437257326
Provider Name (Legal Business Name): RADHA V KUDVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE STE 210
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

PO BOX 2080
WILLIAMSON WV
25661-2080
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 304-235-4049
Mailing address:
  • Phone: 304-236-5902
  • Fax: 304-235-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21512
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13149
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: