Provider Demographics
NPI:1700851300
Name:GUNAWARDENA, RATNASIRI (MD)
Entity Type:Individual
Prefix:
First Name:RATNASIRI
Middle Name:
Last Name:GUNAWARDENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KEMPSVILLE RD STE 100E
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5744
Mailing Address - Fax:757-261-0321
Practice Address - Street 1:850 KEMPSVILLE RD STE 100E
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-5744
Practice Address - Fax:757-261-0321
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013994174400000X
VA0101239066207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208828608Medicaid
MO208828608Medicaid
MO990521390Medicare ID - Type Unspecified