Organization
PADMA WIJETILLEKE,MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PADMA P WIJETILLEKE M.D. (PHYSICIAN)
(703) 379-0704
Entity
Organization
Contact information
Practice address
611 S CARLIN SPRINGS RD, STE 101, ARLINGTON, VA 22204-1064
(703) 379-0704
(703) 379-7947
Mailing address
611 S CARLIN SPRINGS RD, STE 101, ARLINGTON, VA 22204-1064
(703) 379-0704
(703) 379-7947
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0101033749
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6716059
—
VA
Enumeration date
03/23/2010
Last updated
03/23/2010
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