Provider Demographics
NPI:1912232307
Name:WIJERATHNA, HERATH M (MD)
Entity type:Individual
Prefix:DR
First Name:HERATH
Middle Name:M
Last Name:WIJERATHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:H.M. NIRMALA
Other - Middle Name:DAYANI
Other - Last Name:WIJERATHNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:188 WORCESTER PROVIDENCE TPKE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-1908
Practice Address - Country:US
Practice Address - Phone:508-865-3650
Practice Address - Fax:508-865-3822
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265447207R00000X
WI57282-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine