Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD61031268 | WA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD61031268 | WA |
NPI | 1073925087 |
---|---|
Provider Name | Thiran Udawatta |
First Address | Bellingham, WA 98225-1813 |
Second Address | Bellingham, WA 98225-1813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2014 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2154392 | (05) | WA |
440477 | WA LABOR & INDUSTRIES (01) | WA |