Provider Demographics
NPI:1821160938
Name:MARASINGHE, THILINA PRANEETHBOGATEGEDARA (MD)
Entity Type:Individual
Prefix:DR
First Name:THILINA
Middle Name:PRANEETHBOGATEGEDARA
Last Name:MARASINGHE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2455 NE LOOP 410
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5649
Mailing Address - Country:US
Mailing Address - Phone:210-599-6000
Mailing Address - Fax:210-657-5586
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-657-5586
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM4871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199419602Medicaid
TXP00379667OtherRR MEDICARE
TX199419603OtherWELLMED MEDICAID
TX8W9000OtherBCBS
TXTXB158721OtherWELLMED MEDICARE
TX169664Medicare UPIN
TX199419602Medicaid