Basic Information
| Provider Information | |||||||||
| NPI: | 1346242534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUNASEKERA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3535 PENTAGON BLVD STE 330 | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454311705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377579449 | ||||||||
| FaxNumber: | 9377024944 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 COMMONS BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375583021 | ||||||||
| FaxNumber: | 9375583026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35-06-5843 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0947926 | 05 | OH | MEDICAID |