Provider Demographics
NPI:1124132873
Name:CHOLMONDELEY, TESSA M (MD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:M
Last Name:CHOLMONDELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 TOWN CENTER DR STE 207
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3236
Mailing Address - Country:US
Mailing Address - Phone:703-435-2227
Mailing Address - Fax:703-435-7856
Practice Address - Street 1:1830 TOWN CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3236
Practice Address - Country:US
Practice Address - Phone:703-435-2227
Practice Address - Fax:703-435-7856
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006080197Medicaid
VA006080197Medicaid
F04137Medicare UPIN