Individual
DR. PRASHANTHI BORA KODURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3920 BRIDGE RD, BLDG A, STE. 207, SUFFOLK, VA 23435-1117
(757) 983-2200
(757) 923-2201
Mailing address
3920 BRIDGE RD, BLDG A, STE. 207, SUFFOLK, VA 23435-1117
(757) 983-2200
(757) 923-2201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
101229036
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10048061
—
VA
Enumeration date
05/09/2006
Last updated
12/06/2019
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