Provider Demographics
NPI:1659689693
Name:DEWUNDARA, SAMANTHA SHARMINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:SHARMINI
Last Name:DEWUNDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:PATABENDIGE SAMANTHA
Other - Middle Name:SHARMINI
Other - Last Name:DEWUNDARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 CORPORATE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4975
Mailing Address - Country:US
Mailing Address - Phone:757-622-2200
Mailing Address - Fax:757-965-9493
Practice Address - Street 1:241 CORPORATE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4975
Practice Address - Country:US
Practice Address - Phone:757-622-2200
Practice Address - Fax:757-965-9493
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659689693OtherHUMANA
VA547397OtherANTHEM BCBS
VA1659689693Medicaid
VA10152490OtherOPTIMA
VA1659689693OtherVIRGINIA PREMIER
VAP01548824OtherRR MEDICARE
VA1659689693OtherCIGNA
VA1659689693OtherAETNA/COVENTRY
VA1659689693OtherUNITED HEALTHCARE
VA1659689693OtherVIRGINIA HEALTH NETWORK
NC1659689693Medicaid
VA1659689693OtherUNITED HEALTHCARE