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Organization
SOUTHSIDE PHYSICIANS FOR WOMEN, LLC
Active
Organization
SOUTHSIDE PHYSICIANS FOR WOMEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISHNA RAO KUDARAVALLI M.D. (OWNER)
(804) 862-3455
Entity
Organization
Contact information
Practice address
510 S SYCAMORE ST, SUITE A & B, PETERSBURG, VA 23803-5044
(804) 862-3455
(804) 862-1439
Mailing address
510 S SYCAMORE ST, SUITE A & B, PETERSBURG, VA 23803-5044
(804) 862-3455
(804) 862-1439
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
06/25/2007
Last updated
11/13/2007
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