Healthcare Provider Details

I. General information

NPI: 1689932188
Provider Name (Legal Business Name): DR. RUKMALEE ERANDIKA VITHANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST RM M2303
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5987
  • Fax: 410-955-8718
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD85290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: