Provider Demographics
NPI:1225564198
Name:TESSA CHOLMONDELEY MD PC
Entity Type:Organization
Organization Name:TESSA CHOLMONDELEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-435-2227
Mailing Address - Street 1:1830 TOWN CENTER DR STE 207
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3236
Mailing Address - Country:US
Mailing Address - Phone:703-435-2227
Mailing Address - Fax:703-435-7856
Practice Address - Street 1:1830 TOWN CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3236
Practice Address - Country:US
Practice Address - Phone:703-435-2227
Practice Address - Fax:703-435-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF04137Medicare UPIN
VA694842M86Medicare PIN