DR. KRISHNA RAO KUDARAVALLI (NPI# 1104810142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104810142 |
| Entity Type | Individual |
| Full Name | DR. KRISHNA RAO KUDARAVALLI |
| Credential | M.D |
| Practice Address |
210 Medical Park Boulevard Suite 150 Petersburg VA 23805-9274 |
| Mailing Address |
436 Clairmont Ct Ste 105 Colonial Heights VA 23834-1765 |
| Practice Telephone | 8047655206 |
| Practice Fax Number | 8047655809 |
| Mailing Telephone | 8047655206 |
| Mailing Fax Number | 8047655809 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2018-01-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 0101033170 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 006205411 | 05 |
| Street Address |
210 MEDICAL PARK BOULEVARD SUITE 150 |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508074931 | Shannon Charisse Gilham | Obstetrics & Gynecology | 210 Medical Park Boulevard, Suite 150, Petersburg, VA 23805-9214 | 2007-05-18 |
| 1134229057 | Paul J Meyers | Obstetrics & Gynecology | 210 Medical Park Boulevard, Suite 150, Petersburg, VA 23805-9274 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699202150 | John L Hahn Md Inc | Obstetrics & Gynecology | 10 Valley St Ste 101, Petersburg, WV 26847-9568 | 2017-05-16 |
| 1518278118 | Amanda Marie Borror | Obstetrics & Gynecology | 65 Hospital Dr Ste 104, Petersburg, WV 26847 | 2010-06-29 |
| 1417095456 | Miguel Vega-gilormini | Obstetrics & Gynecology | 210 Medical Park Blvd Ste 150, Petersburg, VA 23805 | 2007-02-02 |
| 1245291186 | Pannala Vijay Reddy | Obstetrics & Gynecology | 510 S Sycamore St, Ste D, Petersburg, VA 23803 | 2006-03-30 |
| 1609843994 | Martin Jourden | Obstetrics & Gynecology | 50 Medical Park Blvd., Suite A, Petersburg, VA 23805-9274 | 2006-03-05 |
| 1831190446 | John L Hahn | Obstetrics & Gynecology | 65 Hospital Dr, Suite 104, Petersburg, WV 26847-9549 | 2005-08-04 |
| 1427579424 | Grant Memorial Hospital | Obstetrics & Gynecology | 65 Hospital Dr Ste 104, Petersburg, WV 26847-9549 | 2017-06-29 |
| 1033389440 | Southside Specialists for Women, P.C. | Obstetrics & Gynecology | 510 S Sycamore St, Suite D, Petersburg, VA 23803-5044 | 2008-03-03 |
| 1811193055 | Southside Physicians for Women, LLC | Obstetrics & Gynecology | 510 S Sycamore St, Suite A & B, Petersburg, VA 23803-5044 | 2007-06-25 |
| 1508074931 | Shannon Charisse Gilham | Obstetrics & Gynecology | 210 Medical Park Boulevard, Suite 150, Petersburg, VA 23805-9214 | 2007-05-18 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.