Basic Information
| Provider Information | |||||||||
| NPI: | 1225011539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DASANAYAKA | ||||||||
| FirstName: | GAYANI | ||||||||
| MiddleName: | YAHAMPATH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 N ELM STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365445400 | ||||||||
| FaxNumber: | 3365445401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 N ELM STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365445400 | ||||||||
| FaxNumber: | 3365445401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 200101539 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89135NE | 05 | NC | MEDICAID |