Provider Demographics
NPI:1720210800
Name:WIJEWICKRAMA, ROHAN CHANDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROHAN
Middle Name:CHANDANA
Last Name:WIJEWICKRAMA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:DIVISION OF OTOLARYNGOLOGY (SMC-8)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:857-321-0968
Mailing Address - Fax:617-789-5088
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:DIVISION OF OTOLARYNGOLOGY (SMC-8)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:857-321-0968
Practice Address - Fax:617-789-5088
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY00000000207Y00000X
MA246894207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology