Provider Demographics
NPI:1952633729
Name:DHARMA MD PA
Entity Type:Organization
Organization Name:DHARMA MD PA
Other - Org Name:SOUTHWEST FAMILY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARMAGUNARATNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-393-2940
Mailing Address - Street 1:8877 HARRY HINES BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1715
Mailing Address - Country:US
Mailing Address - Phone:214-393-2940
Mailing Address - Fax:241-393-2945
Practice Address - Street 1:8877 HARRY HINES BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1715
Practice Address - Country:US
Practice Address - Phone:214-393-2940
Practice Address - Fax:241-393-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00136LOtherMEDICARE
TX00136LOtherMEDICARE