| Rohini Wijetilleke Md Pc | |
|
100 Elden Street Suite 14 Herndon VA 20170 | |
| (703) 471-7733 | |
| (703) 471-7733 |
| Full Name | Rohini Wijetilleke Md Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 100 Elden Street, Herndon, Virginia |
| Authorized Official Name and Position | Rohini Wijetilleke (MD PC) |
| Authorized Official Contact | 7034717733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rohini Wijetilleke Md Pc 100 Elden Street Suite 14 Herndon VA 20170 Ph: (703) 471-7733 | Rohini Wijetilleke Md Pc 100 Elden Street Suite 14 Herndon VA 20170 Ph: (703) 471-7733 |
| NPI Number | 1942215330 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 11/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942215330 | NPI | - | NPPES |
| 210923 | Other | BLUE CROSS BS | |
| 5618410 | Medicaid | VA | |
| 281178 | Other | AMERIGROUP | |
| 6711324 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35528 (Virginia) | Secondary |
| 208000000X | Pediatrics | 35528 (Virginia) | Primary |
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