Provider Demographics
NPI:1174594758
Name:DINGMAN, ACHINI PERERA (MD)
Entity type:Individual
Prefix:
First Name:ACHINI
Middle Name:PERERA
Last Name:DINGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ACHINI
Other - Middle Name:CHAMPA
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1948 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2452
Practice Address - Country:US
Practice Address - Phone:208-514-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD60427174400000X
IDM-10246207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD105845OtherKAISER PROVIDER #
MD62009401OtherBCBS MD PROV #
MDT6320004OtherBCBS FEDERAL PROV #
MDP00063033OtherTRAVELERS RR MEDICARE
MDP00063033OtherTRAVELERS RR MEDICARE
MDH86491Medicare UPIN