Provider Demographics
NPI:1194773481
Name:WICKRAMASINGHE, EARDLY K P (MD)
Entity type:Individual
Prefix:DR
First Name:EARDLY
Middle Name:K P
Last Name:WICKRAMASINGHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2863
Mailing Address - Country:US
Mailing Address - Phone:412-937-8887
Mailing Address - Fax:412-937-9221
Practice Address - Street 1:1227 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2863
Practice Address - Country:US
Practice Address - Phone:412-937-8887
Practice Address - Fax:412-937-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034527L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000761185Medicaid
PA000112881OtherHIGHMARK BCBS
PAD68785Medicare UPIN
PA0007611850011Medicaid