Healthcare Provider Details

I. General information

NPI: 1720186430
Provider Name (Legal Business Name): HIRANYA RAJASINGHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 GOODLETTE RD N SUITE 102
NAPLES FL
34103-4595
US

IV. Provider business mailing address

2450 GOODLETTE RD N SUITE 102
NAPLES FL
34103-4595
US

V. Phone/Fax

Practice location:
  • Phone: 239-643-8794
  • Fax: 239-430-7820
Mailing address:
  • Phone: 239-643-8794
  • Fax: 239-430-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME86677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: