Provider Demographics
NPI:1912179524
Name:BULATHSINGHALA, CHINTHAKA PUBUDU (MBBS (COLOMBO), MD)
Entity type:Individual
Prefix:DR
First Name:CHINTHAKA
Middle Name:PUBUDU
Last Name:BULATHSINGHALA
Suffix:
Gender:M
Credentials:MBBS (COLOMBO), MD
Other - Prefix:
Other - First Name:RATHU
Other - Middle Name:GAMAGE
Other - Last Name:BULATHSINGHALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:201-358-5909
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4000
Practice Address - Fax:210-358-4775
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPHYSICIAN/OSTEOPATH207R00000X
TXP9307207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT49193OtherSTATE BOARD