Krishna Rao Kudaravalli, M.D

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

0101033170 Issued in VA

Practice address

210 Medical Park Boulevard
Suite 150
Petersburg, VA 23805-9274

Phone

(804) 765-5206

Fax

(804) 765-5809

NPI assigned

Sep 6, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516320000000",
    "number": "1104810142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 CLAIRMONT CT STE 105",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341765",
            "telephone_number": "804-765-5206",
            "fax_number": "804-765-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MEDICAL PARK BOULEVARD",
            "address_2": "SUITE 150",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5206",
            "fax_number": "804-765-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDARAVALLI",
        "first_name": "KRISHNA",
        "middle_name": "RAO",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2018-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101033170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006205411",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Butchaiah Kondragunta, M.D.
• Sakuntla Kondragunta, M.D.
• Charles Konigsberg Jr., MD
• Tuula H Koraska, L.C.S.W.
• Hannah Kathryn Kraus, FNP-BC
• Laboratory Corporation of America Holdings
• Richelle Lackey, PA-C
• Neha Hyderali Lalani, M.D
• Nathan E Langer, M.D.
• Peyton Michael Lassiter, LPC

• Obstetrics & Gynecology Physician in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Obstetrics & Gynecology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.