Provider Demographics
NPI:1558631325
Name:WIJESEKERA, NAMITA GUPTA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAMITA
Middle Name:GUPTA
Last Name:WIJESEKERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAMITA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2352
Mailing Address - Country:US
Mailing Address - Phone:203-397-5211
Mailing Address - Fax:203-397-1875
Practice Address - Street 1:8 LUNAR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2352
Practice Address - Country:US
Practice Address - Phone:203-397-5211
Practice Address - Fax:203-397-1875
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049196208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine