Individual
DR. BUTCHAIAH KONDRAGUNTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34 MEDICAL PARK BLVD STE G, 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
05
—
005839777
—
VA
05
—
005847141
—
VA
01
—
1316020399
HEMATOLOGY/ONCOLOGY
VA
01
—
258076
BCBS
VA
01
—
26641
CIGNA
VA
01
—
337600
BCBS
VA
01
—
541989200
MAILHANDLERS
VA
01
—
7608086
AETNA
VA
Enumeration date
02/14/2006
Last updated
05/22/2012
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