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Individual

DR. SURAJ S VENNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-4724
(571) 472-0241
Mailing address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-4724
(571) 472-0241

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101255078
VA
207N00000X
Dermatology Physician
218355
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2100550
MA
Enumeration date
10/31/2005
Last updated
11/27/2023
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