Provider Demographics
NPI:1760832372
Name:GAJADEERA, DEVMITH CHINTHAKA (MD)
Entity Type:Individual
Prefix:MR
First Name:DEVMITH
Middle Name:CHINTHAKA
Last Name:GAJADEERA
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 1:101 AUBREYS LOOP
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-5054
Mailing Address - Country:US
Mailing Address - Phone:434-517-3879
Mailing Address - Fax:434-517-3989
Practice Address - Street 1:101 AUBREYS LOOP
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5054
Practice Address - Country:US
Practice Address - Phone:434-517-3879
Practice Address - Fax:434-517-3989
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT390200000X
VA0101265951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program