MEDICARE: TEJASWI REDDY VOOTLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	280504	NY
2	207R00000X	Internal Medicine Physician	32889	WV

General Provider Information

NPI Number	:	1164780011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJASWI REDDY VOOTLA M.D.

Provider Business Mailing Address
First Line	:	220 CAMPUS BLVD STE 320
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2889
Country	:	US
Telephone Number	:	540-536-5100
Fax Number	:	540-536-0235

Provider Business Practice Location Address
First Line	:	3774 VALLEY RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-4614
Country	:	US
Telephone Number	:	304-258-9433
Fax Number	:	304-258-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2012
Last Update Date	:	02/06/2026

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