Provider Demographics
NPI:1225064512
Name:SAMARASINGHE, GUNASIRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GUNASIRI
Middle Name:
Last Name:SAMARASINGHE
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 1:5709 LONGRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7891
Mailing Address - Country:US
Mailing Address - Phone:540-725-7364
Mailing Address - Fax:540-725-7368
Practice Address - Street 1:5372 FALLOWATER LN
Practice Address - Street 2:SUITEA
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0903
Practice Address - Country:US
Practice Address - Phone:540-725-7364
Practice Address - Fax:540-725-7368
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101055071207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265113OtherBC/BS PROVIDER#
VA050069396OtherMC RR
VAVA0050975OtherTRICARE PROVIDER#
VA700021567OtherCIGNA PROVIDER#
VA150668800OtherUS DEPT OF LABOR PROVIDER
VA5715547Medicaid
VA8598117002OtherCIGNA HMO PROVIDER#
VATN0101OtherJOHN DEERE PROVIDER#
VA700021567OtherCIGNA PROVIDER#
B40025Medicare UPIN