| Tdmd Primary Care | |
|
1001 Pemberton Hill Rd Ste 202 Apex NC 27502-4265 | |
| (919) 760-5228 | |
| Not Available |
| Full Name | Tdmd Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 Pemberton Hill Rd Ste 202, Apex, North Carolina |
| Authorized Official Name and Position | Thusitha R Dissanayake (OWNER/MANAGING MEMEBER) |
| Authorized Official Contact | 9197605228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tdmd Primary Care 1100 S Alodie Ct Apex NC 27502-5235 Ph: (919) 760-5228 | Tdmd Primary Care 1001 Pemberton Hill Rd Ste 202 Apex NC 27502-4265 Ph: (919) 760-5228 |
| NPI Number | 1629658802 |
|---|---|
| Provider Enumeration Date | 04/12/2021 |
| Last Update Date | 04/17/2021 |
| Certification Date | 04/17/2021 |
| Medicare PECOS PAC ID | 2769852953 |
|---|---|
| Medicare Enrollment ID | O20230104001852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629658802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Thusitha R Dissanayake |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073810537 PECOS PAC ID: 1951522556 Enrollment ID: I20141023002500 |
| Provider Name | Maliaka Kai Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396954103 PECOS PAC ID: 8325029820 Enrollment ID: I20200407001760 |
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