Provider Demographics
NPI:1609831544
Name:KODURI, RAMESH B (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:B
Last Name:KODURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:269 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9337
Mailing Address - Country:US
Mailing Address - Phone:804-861-0700
Mailing Address - Fax:804-863-4626
Practice Address - Street 1:269 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9337
Practice Address - Country:US
Practice Address - Phone:804-861-0700
Practice Address - Fax:804-863-4626
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010244182084A0401X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry