Provider Demographics
NPI:1689844243
Name:WEERATUNGE, KUMARI K (MD)
Entity Type:Individual
Prefix:
First Name:KUMARI
Middle Name:K
Last Name:WEERATUNGE
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 1:204 W PARK
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9336
Mailing Address - Country:US
Mailing Address - Phone:936-327-8661
Mailing Address - Fax:936-327-3131
Practice Address - Street 1:1401 ANDOVER LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2685
Practice Address - Country:US
Practice Address - Phone:936-327-8661
Practice Address - Fax:936-327-3131
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM90872080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193150303Medicaid