Provider Demographics
NPI:1699765024
Name:KERNODLE, WILLIAM D (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:KERNODLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-320-7881
Mailing Address - Fax:804-560-3474
Practice Address - Street 1:1000 BOULDERS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-320-7881
Practice Address - Fax:804-560-3474
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010258532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007157991Medicaid
VAB60198Medicare UPIN
VA007157991Medicaid