Provider Demographics
NPI:1699463026
Name:WANNIACHCHIGE, UVINDU ADISHA (DO)
Entity type:Individual
Prefix:MR
First Name:UVINDU
Middle Name:ADISHA
Last Name:WANNIACHCHIGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1302
Mailing Address - Country:US
Mailing Address - Phone:703-678-8939
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6797
Practice Address - Country:US
Practice Address - Phone:301-714-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program