Individual
JAYASIRI RAVINATH FERNANDO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
907 W LINCOLN AVE, CHARLESTON, IL 61920-2413
(217) 345-2100
(217) 345-8366
Mailing address
907 W LINCOLN AVE, PO BOX 770, CHARLESTON, IL 61920-2413
(217) 345-2100
(217) 345-8366
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Enumeration date
12/16/2005
Last updated
07/08/2007
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