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Individual

DR. LALITH WIJAYASURIYA

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1214 COOLIDGE BLVD, LAFAYETTE, LA 70503-2621
(337) 261-2697
Mailing address
PO BOX 53127, LAFAYETTE, LA 70505-3127
(337) 261-2697

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5456R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1312207
LA
05
5M176
LA
Enumeration date
10/11/2005
Last updated
07/08/2007
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