1659689693 NPI number — DR. SAMANTHA SHARMINI DEWUNDARA MD

Table of content: DR. SAMANTHA SHARMINI DEWUNDARA MD (NPI 1659689693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659689693 NPI number — DR. SAMANTHA SHARMINI DEWUNDARA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWUNDARA
Provider First Name:
SAMANTHA
Provider Middle Name:
SHARMINI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEWUNDARA
Provider Other First Name:
PATABENDIGE SAMANTHA
Provider Other Middle Name:
SHARMINI
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659689693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 CORPORATE BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-4975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-622-2200
Provider Business Mailing Address Fax Number:
757-965-9493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 CORPORATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-4975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-622-2200
Provider Business Practice Location Address Fax Number:
757-965-9493
Provider Enumeration Date:
09/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101258106 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659689693 . This is a "HUMANA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 547397 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10152490 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P01548824 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 . This is a "AETNA/COVENTRY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659689693 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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