Provider Demographics
NPI:1093881567
Name:KRATOVIL, KRISTINA REA BLACK (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:REA BLACK
Last Name:KRATOVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:REA
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6333 CENTER DR BLDG 16
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4126
Mailing Address - Country:US
Mailing Address - Phone:757-252-9500
Mailing Address - Fax:757-962-9801
Practice Address - Street 1:6333 CENTER DR BLDG 16
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4126
Practice Address - Country:US
Practice Address - Phone:757-252-9500
Practice Address - Fax:757-962-9801
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine