Provider Demographics
NPI:1356395941
Name:SAMARAKOON, PRIYAN (MD)
Entity type:Individual
Prefix:
First Name:PRIYAN
Middle Name:
Last Name:SAMARAKOON
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 1:570 NEW WAVERLY PL STE 140
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7405
Mailing Address - Country:US
Mailing Address - Phone:919-439-8580
Mailing Address - Fax:919-463-5600
Practice Address - Street 1:570 NEW WAVERLY PL STE 140
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7405
Practice Address - Country:US
Practice Address - Phone:919-439-8580
Practice Address - Fax:919-463-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01120207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
SC28542207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1356395941OtherMEDCOST
SC285426Medicaid
SC7398806OtherCIGNA HEALTHCARE
SC7462841OtherAETNA
SCP00353038OtherRR MEDICARE
SC20088388OtherSELECT HEALTH
SC593303026005OtherBCBS
SC1356395941OtherWELLPATH
NC5905335Medicaid
SC273038OtherUNISON
SC6674Medicare PIN
SC273038OtherUNISON
SC7462841OtherAETNA
SCAA15036674Medicare PIN