Provider Demographics
NPI:1093780728
Name:GUNAWARDANE, RUWANI DP (MD)
Entity Type:Individual
Prefix:DR
First Name:RUWANI
Middle Name:DP
Last Name:GUNAWARDANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10312 CASTLEFIED STREET
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5853
Mailing Address - Country:US
Mailing Address - Phone:410-465-3646
Mailing Address - Fax:
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-490-6085
Practice Address - Fax:301-490-3873
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00471192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG47603Medicare UPIN