1710218144 NPI number — DR. INDIKA THARANGANIE HEVA- PATHTHINIGE MD

Table of content: DR. INDIKA THARANGANIE HEVA- PATHTHINIGE MD (NPI 1710218144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710218144 NPI number — DR. INDIKA THARANGANIE HEVA- PATHTHINIGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEVA- PATHTHINIGE
Provider First Name:
INDIKA
Provider Middle Name:
THARANGANIE
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710218144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504
Provider Second Line Business Mailing Address:
MEDICAL CENTER DRIVE
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-538-6300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17200 ST LUKES WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-8007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-266-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2010

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: 207Q00000X , with the licence number:  57.015989 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: P5379 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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