Provider Demographics
NPI:1669453593
Name:FERNANDO, KALUGAMAGE RANJIT (MD)
Entity type:Individual
Prefix:
First Name:KALUGAMAGE
Middle Name:RANJIT
Last Name:FERNANDO
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 1:3722 CENTRAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8247
Mailing Address - Country:US
Mailing Address - Phone:239-936-1920
Mailing Address - Fax:239-936-0371
Practice Address - Street 1:3722 CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8247
Practice Address - Country:US
Practice Address - Phone:239-936-1920
Practice Address - Fax:239-936-0371
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 30595207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82557Medicare UPIN
FL79129ZMedicare PIN