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General NPI Number Information
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NPI Number | 1679546923
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Entity Type | Individual
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Provider Name | KADARNATH SHAMMIE BOODRAM MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 03/10/2024
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Provider Practice Location Address
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Address Line | 4300 CROSSINGS BLVD STE 101
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1452
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Country | US
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Telephone | 804-526-7900
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Fax | 804-526-7195
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Provider Business Mailing Address
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Address Line | 410 RAVENSCROFT RD
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City | SOUTH PRINCE GEORGE
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State | VA
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Zip | 23805-7121
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Country | US
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Telephone | 804-526-7900
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Fax | 804-526-7195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101229800
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License Number State | VA
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