Individual
SURESH GEHAN JAYATILAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1129 N MAIN ST STE G, SOUTH BOSTON, VA 24592-2547
(434) 572-8196
(434) 572-8341
Mailing address
503 RIDGE RD, ROXBORO, NC 27573-4627
(336) 503-5757
(336) 322-4350
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101241180
VA
207RG0100X
Gastroenterology Physician
Primary
2011-00253
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265557953
—
NC
Enumeration date
03/20/2007
Last updated
05/16/2022
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