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General NPI Number Information
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NPI Number | 1225064512
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Entity Type | Individual
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Provider Name | GUNASIRI SAMARASINGHE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5372 FALLOWATER LN SUITEA
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City | ROANOKE
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State | VA
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Zip | 24018-0903
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Country | US
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Telephone | 540-725-7364
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Fax | 540-725-7368
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Provider Business Mailing Address
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Address Line | 5709 LONGRIDGE CIR
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City | ROANOKE
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State | VA
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Zip | 24018-7891
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Country | US
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Telephone | 540-725-7364
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Fax | 540-725-7368
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | VA0101055071
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License Number State | VA
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