1043088974 NPI number — DR. CHAMILA NIROSHANA RUPASINGHE

Table of content: DR. CHAMILA NIROSHANA RUPASINGHE (NPI 1043088974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043088974 NPI number — DR. CHAMILA NIROSHANA RUPASINGHE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUPASINGHE
Provider First Name:
CHAMILA
Provider Middle Name:
NIROSHANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1043088974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4367 MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-657-7496
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 NUTMEG DR STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-5495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
475-208-1621
Provider Business Practice Location Address Fax Number:
888-503-3516
Provider Enumeration Date:
12/20/2023

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: 247ZC0005X , with the licence number:  RUPAC1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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