Provider Demographics
NPI:1659546505
Name:RANATHUNGA, LAKMALI CHANDIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKMALI
Middle Name:CHANDIMA
Last Name:RANATHUNGA
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 1:10893 BLACKBIRD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0864
Mailing Address - Country:US
Mailing Address - Phone:937-866-6128
Mailing Address - Fax:
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6250
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-8394
Practice Address - Fax:937-208-8388
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013161A390200000X
OH35.093445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2961666Medicaid
OH2961666Medicaid
OH4268543Medicare PIN