Individual
TEJAS SURESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7901 LAKE MANASSAS DR, GAINESVILLE, VA 20155-3257
(703) 208-3155
(571) 222-2202
Mailing address
3040 WILLIAMS DR STE 100, FAIRFAX, VA 22031-4618
(571) 350-8400
(703) 940-8697
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0101272283
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679836365
—
VA
01
—
2I4567
MEDICARE PTAN
VA
01
—
VAC899A
MEDICARE PTAN
DC
Enumeration date
06/19/2012
Last updated
10/24/2022
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