ANNESLEY T DE VASGUNAWARDHANE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

ANNESLEY T DE

Last Name

VASGUNAWARDHANE

Suffix

Business Name

ANNESLEY T DE VASGUNAWARDHANE MD

Original Issue Date

01/01/1997

Effective Date

07/13/2011

Expiration Date

07/31/2014

City

CLIFTON

State

Zip

60927

County

IROQUOIS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014