Provider Demographics
NPI:1083773550
Name:GUNAWARDENA, YAMANI (MD)
Entity Type:Individual
Prefix:
First Name:YAMANI
Middle Name:
Last Name:GUNAWARDENA
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 1:1246 ASHLAND AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-450-6147
Mailing Address - Fax:740-450-6157
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-454-5398
Practice Address - Fax:740-455-7580
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2549273Medicaid
OH2549273Medicaid