MEDICARE: DR. TEJA VENKATAHARA SURAPANENI 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	16950A	WY
2	208M00000X	Hospitalist Physician	16571	NV
3	208M00000X	Hospitalist Physician	MD217937	OR
4	207R00000X	Internal Medicine Physician	16571	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275875130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEJA VENKATAHARA SURAPANENI M.D.

Provider Business Mailing Address
First Line	:	9205 W RUSSELL RD STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1425
Country	:	US
Telephone Number	:	702-430-7801
Fax Number	:	702-444-2535

Provider Business Practice Location Address
First Line	:	4871 N TEE PEE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2505
Country	:	US
Telephone Number	:	702-430-7801
Fax Number	:	702-444-2535

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	06/18/2025

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