Basic Information
| Provider Information | |||||||||
| NPI: | 1134490931 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIANCE PHYSICIANS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOSEPH N GUNASEKERA, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 COMMONS BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583021 | ||||||||
| FaxNumber: | 9375583026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 COMMONS BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583021 | ||||||||
| FaxNumber: | 9375583026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2012 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHELDON | ||||||||
| AuthorizedOfficialFirstName: | DUANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 9373844838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALLIANCE PHYSICIANS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35065843 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.