Provider Demographics
NPI:1184695843
Name:KONDRAGUNTA, SAKUNTLA (MD)
Entity type:Individual
Prefix:DR
First Name:SAKUNTLA
Middle Name:
Last Name:KONDRAGUNTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9274
Mailing Address - Country:US
Mailing Address - Phone:804-765-5991
Mailing Address - Fax:804-765-5809
Practice Address - Street 1:200 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:804-765-5991
Practice Address - Fax:804-765-5809
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222345207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184695843OtherANTHEM BCBS
VA010107318Medicaid
VA1184695843Medicaid
H09170Medicare UPIN
VA00W006K01Medicare ID - Type UnspecifiedMEDICARE
VA1184695843Medicaid
VAP00722726Medicare PIN