Provider Demographics
NPI:1871510586
Name:WIKRAMANAYAKE, TILAK WIMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:TILAK
Middle Name:WIMAL
Last Name:WIKRAMANAYAKE
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 1:5271 HUNTING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8722
Mailing Address - Country:US
Mailing Address - Phone:917-693-9253
Mailing Address - Fax:
Practice Address - Street 1:5271 HUNTING HILLS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8722
Practice Address - Country:US
Practice Address - Phone:917-693-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
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112424557WI03OtherCAREPLUS HEALTH PLAN
164680101OtherHEALTHCARE PLUS
112424557OtherMULTIPLAN, INC
166517OtherELDERPLAN
NY040426030250OtherFIDELIS CARE OF NEW YORK
P2527450OtherOXFORD HEALTH PLANS
NY02200911Medicaid
31P1291OtherNY PRESBYTERIAN COMM HEAL