Suresh Jayantha Desilva, MD | |
21332 Nautique Blvd, Apt # 204, Cornelius, NC 28031-6410 | |
(704) 650-3789 | |
Not Available |
Full Name | Suresh Jayantha Desilva |
---|---|
Gender | Male |
Speciality | Emergency Medicine |
Location | 21332 Nautique Blvd, Cornelius, North Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356304869 | NPI | - | NPPES |
89107OL | Medicaid | NC | |
2246349F | Other | NC | MEDICARE PART B PROVIDER # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 00971315 (North Carolina) | Secondary |
207P00000X | Emergency Medicine | 13961 (Nevada) | Primary |
Entity Name | East Carolina Health-bertie |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1578541660 PECOS PAC ID: 1355251661 Enrollment ID: O20041112000143 |
Entity Name | The Carolinas Emergency Group, Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1477508836 PECOS PAC ID: 2567486814 Enrollment ID: O20060125000577 |
Entity Name | Vidant Medical Group Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1477648731 PECOS PAC ID: 0345343893 Enrollment ID: O20070321000445 |
Entity Name | Sampson Regional Emergency Professional Services, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1952819575 PECOS PAC ID: 6406119239 Enrollment ID: O20180409002720 |
Mailing Address | Practice Location Address |
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Suresh Jayantha Desilva, MD 21332 Nautique Blvd, Apt # 204, Cornelius, NC 28031-6410 Ph: (704) 650-3789 | Suresh Jayantha Desilva, MD 21332 Nautique Blvd, Apt # 204, Cornelius, NC 28031-6410 Ph: (704) 650-3789 |