Provider Demographics
NPI:1043303183
Name:BANDARA, ANOMA PRIYADHARSHANI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANOMA
Middle Name:PRIYADHARSHANI
Last Name:BANDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19241 MONTGOMERY VILLAGE AVENUE
Mailing Address - Street 2:SUITE E23
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5036
Mailing Address - Country:US
Mailing Address - Phone:301-948-0098
Mailing Address - Fax:301-926-9180
Practice Address - Street 1:19241 MONTGOMERY VILLAGE AVENUE
Practice Address - Street 2:SUITE E23
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5036
Practice Address - Country:US
Practice Address - Phone:301-948-0098
Practice Address - Fax:301-926-9180
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87985Medicare UPIN
674973M56Medicare ID - Type Unspecified