Provider Demographics
NPI:1912967746
Name:SUREJA, RAJ N (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:N
Last Name:SUREJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:250 NAT TURNER BLVD S
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2899
Mailing Address - Country:US
Mailing Address - Phone:757-596-1900
Mailing Address - Fax:866-420-0168
Practice Address - Street 1:250 NAT TURNER BLVD S
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2899
Practice Address - Country:US
Practice Address - Phone:757-596-1900
Practice Address - Fax:866-420-0168
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237818208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211352Medicaid
VA010211352Medicaid
VA008403P95 - C03895Medicare ID - Type Unspecified