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General NPI Number Information
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NPI Number | 1942215330
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Entity Type | Organization
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Legal Business Name | ROHINI WIJETILLEKE MD PC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 100 ELDEN STREET SUITE 14
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City | HERNDON
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State | VA
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Zip | 20170
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Country | US
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Telephone | 703-471-7733
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Fax | 703-471-7733
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Provider Business Mailing Address
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Address Line | 100 ELDEN STREET SUITE 14
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City | HERNDON
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State | VA
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Zip | 20170
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Country | US
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Telephone | 703-471-7733
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Fax | 703-471-7733
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Authorized Official
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Title or Position | MD PC
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Name | DR. ROHINI WIJETILLEKE
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Credential | MD
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Telephone | 703-471-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35528
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35528
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License Number State | VA
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