Provider Demographics
NPI:1437180197
Name:DHARMASENA, KURUPPUNAYAKE S (MD)
Entity Type:Individual
Prefix:DR
First Name:KURUPPUNAYAKE
Middle Name:S
Last Name:DHARMASENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KURUPP
Other - Middle Name:S
Other - Last Name:DHARMASENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7845 OAKWOOD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4256
Mailing Address - Country:US
Mailing Address - Phone:410-553-4182
Mailing Address - Fax:410-553-4983
Practice Address - Street 1:7845 OAKWOOD RD STE 103
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4256
Practice Address - Country:US
Practice Address - Phone:410-553-4182
Practice Address - Fax:410-553-4983
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17753207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB69209Medicare ID - Type Unspecified