Provider Demographics
NPI:1780882449
Name:MOONESINGHE, DESHINI A (MD)
Entity type:Individual
Prefix:
First Name:DESHINI
Middle Name:A
Last Name:MOONESINGHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 BASH ST STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1286
Mailing Address - Country:US
Mailing Address - Phone:317-735-6001
Mailing Address - Fax:855-450-1177
Practice Address - Street 1:8904 BASH ST STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1286
Practice Address - Country:US
Practice Address - Phone:317-735-6001
Practice Address - Fax:855-450-1177
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067139A207RH0002X, 208M00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200991660Medicaid
INP01270914OtherRR MEDICARE
ININ1663021Medicare PIN
IN266180843Medicare PIN
IN200991660Medicaid
INM400065227Medicare PIN
INP00871796Medicare PIN
INP01270914OtherRR MEDICARE