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General NPI Number Information
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NPI Number | 1386899029
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS INFECTIOUS DISEASE PA
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 598 N UNION AVE STE.350
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-4136
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Country | US
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Telephone | 830-625-5103
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Fax | 512-828-7984
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | MANCHACA
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State | TX
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Zip | 78652-1090
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Country | US
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Telephone | 210-771-9147
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Fax | 512-828-7984
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | CHAMALEE N WEERATUNGE
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Credential | MD
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Telephone | 210-771-9147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | M3110
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License Number State | TX
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