Provider Demographics
NPI:1730347949
Name:DHARMASENA, SANATH (MD)
Entity type:Individual
Prefix:DR
First Name:SANATH
Middle Name:
Last Name:DHARMASENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEWANNAHALAGE
Other - Middle Name:SANATH
Other - Last Name:DHARMASENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1290 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6368
Mailing Address - Country:US
Mailing Address - Phone:845-514-4278
Mailing Address - Fax:718-442-8451
Practice Address - Street 1:11 RALPH PL STE 105
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4405
Practice Address - Country:US
Practice Address - Phone:845-514-4278
Practice Address - Fax:888-501-6619
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254605207R00000X, 207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA10715000OtherLICENSE