MEDICARE: DR. SAKUNTLA KONDRAGUNTA 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	0101222345	VA
2	208M00000X	Hospitalist Physician	0101222345	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1184695843	OTHER	VA	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184695843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAKUNTLA KONDRAGUNTA M.D.

Provider Business Mailing Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-765-5991
Fax Number	:	804-765-5809

Provider Business Practice Location Address
First Line	:	200 MEDICAL PARK BLVD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9274
Country	:	US
Telephone Number	:	804-765-5991
Fax Number	:	804-765-5809

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/31/2009

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