Provider Demographics
NPI:1275875130
Name:SURAPANENI, TEJA VENKATAHARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJA
Middle Name:VENKATAHARA
Last Name:SURAPANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9205 W RUSSELL RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1425
Mailing Address - Country:US
Mailing Address - Phone:702-430-7801
Mailing Address - Fax:702-444-2535
Practice Address - Street 1:4871 N TEE PEE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2505
Practice Address - Country:US
Practice Address - Phone:702-430-7801
Practice Address - Fax:702-444-2535
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16571208M00000X, 207R00000X
ORMD217937208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275875130Medicaid
NVV114222Medicare PIN