Provider Demographics
NPI:1679546923
Name:BOODRAM, KADARNATH SHAMMIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KADARNATH
Middle Name:SHAMMIE
Last Name:BOODRAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 RAVENSCROFT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7121
Mailing Address - Country:US
Mailing Address - Phone:804-526-7900
Mailing Address - Fax:804-526-7195
Practice Address - Street 1:4300 CROSSINGS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1452
Practice Address - Country:US
Practice Address - Phone:804-526-7900
Practice Address - Fax:804-526-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101229800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA254668OtherSOUTHERN HEALTH
VA010124701OtherVIRGINIA PREMIERE
VA3689195OtherAETNA HMO
VA7604973OtherGHI
VI94167OtherSENTARA/OPTIMA
VI0408689OtherUNITED HEALTHCARE
VA172714OtherANTHEM BC/BS
VA7404178OtherAETNA PPO
VA0504963OtherCIGNA
VA010124701Medicaid
VA54180OtherCARENET
VA8130003OtherMAMSI
VA7604973OtherGHI
VI0408689OtherUNITED HEALTHCARE
VA010124701OtherVIRGINIA PREMIERE
VA7604973OtherGHI