Provider Demographics
NPI:1437257326
Name:KUDVA, RADHA V (MD)
Entity Type:Individual
Prefix:
First Name:RADHA
Middle Name:V
Last Name:KUDVA
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:PO BOX 2080
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-2080
Mailing Address - Country:US
Mailing Address - Phone:304-236-5902
Mailing Address - Fax:304-235-4049
Practice Address - Street 1:184 E 2ND AVE
Practice Address - Street 2:STE 210
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3602
Practice Address - Country:US
Practice Address - Phone:304-236-5902
Practice Address - Fax:304-235-4049
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21512208000000X
WV13149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64215122Medicaid
370013337OtherRR MEDICARE
WV0112251000Medicaid
1540901Medicare ID - Type Unspecified
WV0112251000Medicaid