Provider Demographics
NPI:1164476081
Name:WICKREMASINGHE, ASELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASELA
Middle Name:
Last Name:WICKREMASINGHE
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 1:808 VAUGHN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-410-8404
Mailing Address - Fax:559-763-4564
Practice Address - Street 1:808 VAUGHN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-410-8404
Practice Address - Fax:559-763-4564
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83398Medicare UPIN
AW318ZMedicare PIN
CA00A564482Medicare ID - Type Unspecified