Provider Demographics
NPI:1164644670
Name:SISIRA RANASINGHE M.D., INC.
Entity Type:Organization
Organization Name:SISIRA RANASINGHE M.D., INC.
Other - Org Name:SURGCYTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SISIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-471-7675
Mailing Address - Street 1:228D, EAST COLLINS ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5394
Mailing Address - Country:US
Mailing Address - Phone:260-471-7675
Mailing Address - Fax:260-471-0701
Practice Address - Street 1:228D, EAST COLLINS ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5394
Practice Address - Country:US
Practice Address - Phone:260-471-7675
Practice Address - Fax:260-471-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U230900291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200299150AMedicaid
IN15D0966899OtherCLIA LABORATORY NUMBER
IN230900Medicare PIN
IN200299150AMedicaid