Healthcare Provider Details

I. General information

NPI: 1245233881
Provider Name (Legal Business Name): SISIRA RANASINGHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228D E COLLINS RD
FORT WAYNE IN
46825-5304
US

IV. Provider business mailing address

228 E COLLINS RD STE D
FORT WAYNE IN
46825-5394
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-7675
  • Fax: 260-471-0701
Mailing address:
  • Phone: 260-471-7675
  • Fax: 260-471-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01026434A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: