Healthcare Provider Details

I. General information

NPI: 1225064512
Provider Name (Legal Business Name): GUNASIRI SAMARASINGHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5372 FALLOWATER LN SUITEA
ROANOKE VA
24018-0903
US

IV. Provider business mailing address

5709 LONGRIDGE CIR
ROANOKE VA
24018-7891
US

V. Phone/Fax

Practice location:
  • Phone: 540-725-7364
  • Fax: 540-725-7368
Mailing address:
  • Phone: 540-725-7364
  • Fax: 540-725-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberVA0101055071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: