Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | MT215396 | PA |
NPI | 1164929089 |
---|---|
Provider Name | Naomi Gunawardena |
First Address | Philadelphia, PA 19103-1542 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2018 |
Last Update Date | 13/07/2021 |