Provider Demographics
NPI:1295822112
Name:BANDARANAYAKE, PICHING S (MD)
Entity Type:Individual
Prefix:DR
First Name:PICHING
Middle Name:S
Last Name:BANDARANAYAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3721
Mailing Address - Country:US
Mailing Address - Phone:412-361-8355
Mailing Address - Fax:412-361-8616
Practice Address - Street 1:5750 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3721
Practice Address - Country:US
Practice Address - Phone:412-361-8355
Practice Address - Fax:412-361-8616
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034913L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW0014375230001Medicaid
PA03219K62Medicare ID - Type Unspecified
PAB29896Medicare UPIN