MEDICARE: PADMA M. ARIYAWANSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD00030248	WA
2	208000000X	Pediatrics Physician	M6126	ID
3	208000000X	Pediatrics Physician	15235	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629051826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PADMA M. ARIYAWANSA MD

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	702-560-2900
Fax Number	:	702-560-2928

Provider Business Practice Location Address
First Line	:	4475 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7826
Country	:	US
Telephone Number	:	702-669-5840
Fax Number	:	702-650-5729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	08/25/2014

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Directions to “ PADMA M. ARIYAWANSA MD” Practice Location

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