Provider Demographics
NPI:1225359623
Name:FERNANDO, CHAMINDA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAMINDA
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GALLERIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1217
Mailing Address - Country:US
Mailing Address - Phone:240-498-7622
Mailing Address - Fax:
Practice Address - Street 1:1301 S COULTER ST
Practice Address - Street 2:SUITE 405
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1763
Practice Address - Country:US
Practice Address - Phone:806-358-9111
Practice Address - Fax:806-358-3728
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5626208M00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program