Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD465251 | PA |
NPI | 1093058877 |
---|---|
Provider Name | Kanchana Nilupul Herath |
First Address | Philadelphia, PA 17522-8822 |
Second Address | Philadelphia, PA 17522-8822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 24/09/2018 |