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General NPI Number Information
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NPI Number | 1578545182
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Entity Type | Individual
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Provider Name | MAGHA SIRIMEVAN DISSANAYAKE MD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 147 S 52ND PL
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City | SPRINGFIELD
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State | OR
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Zip | 97478-6210
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Country | US
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Telephone | 541-746-1166
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Fax | 541-393-1607
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Provider Business Mailing Address
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Address Line | PO BOX 1517
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City | PENDLETON
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State | OR
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Zip | 97801-0410
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Country | US
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Telephone | 877-708-1119
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Fax | 541-278-8349
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD21258
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License Number State | OR
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