Healthcare Provider Details

I. General information

NPI: 1659345965
Provider Name (Legal Business Name): RANJIT WEERAKOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W TRADE ST
DALLAS NC
28034-1544
US

IV. Provider business mailing address

701 W TRADE ST
DALLAS NC
28034-1544
US

V. Phone/Fax

Practice location:
  • Phone: 704-922-3106
  • Fax: 704-922-1369
Mailing address:
  • Phone: 704-922-3106
  • Fax: 704-922-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: