Provider Demographics
NPI:1073810537
Name:DISSANAYAKE, THUSITHA RUWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THUSITHA
Middle Name:RUWAN
Last Name:DISSANAYAKE
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 1:1100 S ALODIE CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5235
Mailing Address - Country:US
Mailing Address - Phone:919-760-5228
Mailing Address - Fax:
Practice Address - Street 1:1001 PEMBERTON HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4265
Practice Address - Country:US
Practice Address - Phone:919-760-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9791207R00000X
NC2014-01773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine