Individual
CHRISHANTHI PERERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2423 WILLIAMS DR STE 105, GEORGETOWN, TX 78628-3200
(877) 800-5722
(128) 647-2385
Mailing address
205 E UNIVERSITY AVE, SUITE 200, GEORGETOWN, TX 78626-6814
(512) 868-1124
(512) 868-9894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M6825
TX
208000000X
Pediatrics Physician
M6825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1918385-06
—
TX
01
—
M6825
LICENSE
TX
Enumeration date
06/18/2006
Last updated
03/08/2021
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