Provider Demographics
NPI:1023175148
Name:TALREJA, ROSHAN S (MD)
Entity type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:S
Last Name:TALREJA
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 1:1805 COLONIAL MEDICAL COURT
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-481-4475
Mailing Address - Fax:757-481-7650
Practice Address - Street 1:1805 COLONIAL MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-481-4475
Practice Address - Fax:757-481-7650
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001332OtherANTHEM BC
B10190Medicare UPIN