Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 0101254223 | VA |
Y | 2084N0400X | Neurologist | 36700 | SC |
N | 2084N0400X | Neurologist | P0602 | TX |
NPI | 1013185115 |
---|---|
Provider Name | Dr. Priyantha Herath |
First Address | Columbia, SC 29203-6894 |
Second Address | Columbia, SC 29203-8005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 24/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367007 | (05) | SC |