Healthcare Provider Details

I. General information

NPI: 1073810537
Provider Name (Legal Business Name): THUSITHA RUWAN DISSANAYAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PEMBERTON HILL RD STE 202
APEX NC
27502-4265
US

IV. Provider business mailing address

1100 S ALODIE CT
APEX NC
27502-5235
US

V. Phone/Fax

Practice location:
  • Phone: 919-760-5228
  • Fax:
Mailing address:
  • Phone: 919-760-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-9791
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014-01773
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: