Basic Information
| Provider Information | |||||||||
| NPI: | 1992235832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIJETUNGA | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | ARI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 FARM LN | ||||||||
| Address2: | |||||||||
| City: | AMBLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190025001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152872149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199667890 | ||||||||
| FaxNumber: | 9199669533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | 2022-01398 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.