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Individual

DR. IMARA R DISSANAYAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5501 OLD YORK RD, PHILA, PA 19144
(215) 456-6970
(215) 456-7154
Mailing address
101 EAST OLNEY AVE, STE 400, PHILADELPHIA, PA 19120
(215) 456-7000
(215) 254-2599

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD072898L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001866922
PA
Enumeration date
03/31/2006
Last updated
12/09/2011
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