Provider Demographics
NPI:1851694517
Name:PRIYAN SAMARAKOON PLLC
Entity Type:Organization
Organization Name:PRIYAN SAMARAKOON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARAKOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-534-4434
Mailing Address - Street 1:11560 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-7958
Mailing Address - Country:US
Mailing Address - Phone:910-534-4434
Mailing Address - Fax:
Practice Address - Street 1:200 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525
Practice Address - Country:US
Practice Address - Phone:843-586-2292
Practice Address - Fax:843-306-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC - 2009-01120207LC0200X, 207RP1001X, 207RS0012X
SCSC - MD 28542207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty