Healthcare Provider Details

I. General information

NPI: 1952896540
Provider Name (Legal Business Name): NIMALI WEERASOORIYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HADDONFIELD BERLIN RD STE 400
VOORHEES NJ
08043-3514
US

IV. Provider business mailing address

PO BOX 22573
NEW YORK NY
10087-2573
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-7007
  • Fax: 856-435-4372
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMY215870
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: