Individual
SURENDRANATH P EKANAYAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12502 WILLOWBROOK RD, SUITE 550, CUMBERLAND, MD 21502-6491
(301) 723-3940
(301) 723-3941
Mailing address
109 RAYLOC DR, HANCOCK, MD 21750-1518
(301) 678-5187
(301) 678-5797
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
D54964
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288800008
—
PA
05
—
188838001
—
TX
01
—
211849
MEDICARE FQHC
MD
05
—
3810005772
—
WV
05
—
482501200
—
MD
01
—
8G7178
BCBS
TX
Enumeration date
12/19/2005
Last updated
10/31/2017
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