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General NPI Number Information
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NPI Number | 1497965594
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Entity Type | Individual
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Provider Name | RAJITHA L PREMARATNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2005 INJO DR STE 102
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5874
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Country | US
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Telephone | 928-680-4255
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Fax | 928-680-4256
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Provider Business Mailing Address
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Address Line | 2005 INJO DR STE 102
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5874
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Country | US
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Telephone | 928-680-4255
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Fax | 928-680-4256
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 46348
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MO# 2006014659
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License Number State | MO
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