Provider Demographics
NPI:1932336922
Name:RAIYANI, TEJAS V (MD)
Entity type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:V
Last Name:RAIYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JOHN MADDOX DR NW STE A2
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1431
Mailing Address - Country:US
Mailing Address - Phone:706-295-1184
Mailing Address - Fax:706-236-1919
Practice Address - Street 1:100 JOHN MADDOX DR NW STE A2
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1431
Practice Address - Country:US
Practice Address - Phone:706-295-1184
Practice Address - Fax:706-236-1919
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071289A207R00000X
GA074877207R00000X
MI4301505797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201079990Medicaid
INM400076108Medicare PIN
INP01162918Medicare PIN