Provider Demographics
NPI:1306133913
Name:DHARIA, TEJAL (MD)
Entity type:Individual
Prefix:
First Name:TEJAL
Middle Name:
Last Name:DHARIA
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 1:768 BONNIE RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3677
Mailing Address - Country:US
Mailing Address - Phone:860-922-6314
Mailing Address - Fax:
Practice Address - Street 1:15050 HEATHCOTE BLVD
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6251
Practice Address - Country:US
Practice Address - Phone:703-359-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine