Provider Demographics
NPI:1508503277
Name:KAHATHUDUWA, CHANAKA NADEESHAN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANAKA
Middle Name:NADEESHAN
Last Name:KAHATHUDUWA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST RM 3A105
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-743-2391
Mailing Address - Fax:806-743-5687
Practice Address - Street 1:3601 4TH ST RM 3A105
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2391
Practice Address - Fax:806-743-5687
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX746677390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program