Provider Demographics
NPI:1710012851
Name:WIJAYAGUNARATNE, PRIYANTHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANTHA
Middle Name:S
Last Name:WIJAYAGUNARATNE
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:PO BOX 504508 CK
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-289-1600
Mailing Address - Fax:
Practice Address - Street 1:1 LOWER HAVY HILL
Practice Address - Street 2:COMMONWEALTH HEALTH CENTER
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-8950
Practice Address - Fax:670-236-8608
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL026870207P00000X
MP0411208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine