Provider Demographics
NPI:1801124300
Name:VAISHNAV, TEJAS (NP)
Entity type:Individual
Prefix:MR
First Name:TEJAS
Middle Name:
Last Name:VAISHNAV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:TEJAS
Other - Middle Name:
Other - Last Name:VAISHNAV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-983-1036
Mailing Address - Fax:540-855-3458
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-983-1036
Practice Address - Fax:540-855-3458
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001179606163WM0705X
VA0024168438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1801124300Medicaid
VAVV1999AMedicare PIN
VAP00931719Medicare PIN