Organization
S.B.KONDRAGUNTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BUTCHAIAH KONDRAGUNTA M.D (OWNER)
(804) 722-3100
Entity
Organization
Contact information
Practice address
34-G MEDICAL PARK BLVD.,, SUITE - G, PETERSBURG, VA 23805-9283
(804) 722-3100
(804) 722-3120
Mailing address
34 MEDICAL PARK BLVD STE G, SUITE - G, PETERSBURG, VA 23805-9283
(804) 722-3100
(804) 722-3120
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0101223780
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110214242
RAIL ROAD
VA
01
—
1316020399
NPI
VA
01
—
258076
BCBS
VA
05
—
5839777
—
VA
01
—
P00271749
RAIL ROAD
VA
Enumeration date
10/23/2006
Last updated
05/24/2012
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