Healthcare Provider Details

I. General information

NPI: 1598677445
Provider Name (Legal Business Name): MARK WICKRAMASEKERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N KINGS CT
SLIDELL LA
70458-1027
US

IV. Provider business mailing address

303 N KINGS CT
SLIDELL LA
70458-1027
US

V. Phone/Fax

Practice location:
  • Phone: 504-261-0299
  • Fax:
Mailing address:
  • Phone: 504-261-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: