Provider Demographics
NPI:1992827356
Name:RAVAL, TEJAS HARISH (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:HARISH
Last Name:RAVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-765-5320
Mailing Address - Fax:804-765-5325
Practice Address - Street 1:241 CHARLES H DIMMOCK PKWY STE 6
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2915
Practice Address - Country:US
Practice Address - Phone:804-765-5320
Practice Address - Fax:804-765-5325
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2020-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101250918207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992827356Medicaid
1992827356Medicare NSC
VA1992827356Medicaid