Provider Demographics
NPI:1245233881
Name:RANASINGHE, SISIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SISIRA
Middle Name:
Last Name:RANASINGHE
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 1:228 E COLLINS RD STE D
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 E COLLINS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5304
Practice Address - Country:US
Practice Address - Phone:260-471-7675
Practice Address - Fax:260-471-0701
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026434A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200299150Medicaid
IN4896OtherPHYSICIANS HEALTH PLAN
IN000000083909OtherANTHEM BLUE CROSS
IN1111054OtherCIGNA INSURANCE
IN220029374OtherRAIL ROAD MEDICARE
IN3647OtherPARTNERS HEALTH PLAN
IN3647OtherPARTNERS HEALTH PLAN