Provider Demographics
NPI:1790854099
Name:GREAVES, KONDEH AUGUSTA (MD DOCTOR OF MEDICIN)
Entity Type:Individual
Prefix:DR
First Name:KONDEH
Middle Name:AUGUSTA
Last Name:GREAVES
Suffix:
Gender:F
Credentials:MD DOCTOR OF MEDICIN
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Mailing Address - Street 1:807 SANTMYER DR SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5606
Mailing Address - Country:US
Mailing Address - Phone:571-220-7450
Mailing Address - Fax:
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:PRINCE WILLIAM HOSPITAL
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-396-5284
Practice Address - Fax:703-396-8051
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-07-01
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Provider Licenses
StateLicense IDTaxonomies
VA0101234737207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010036534Medicaid
H77929Medicare UPIN
VA010036534Medicaid