Provider Demographics
NPI:1295467421
Name:WALGAMAGE, THILINI (MD)
Entity Type:Individual
Prefix:
First Name:THILINI
Middle Name:
Last Name:WALGAMAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314, CAMPUS ROAD KATUBEDDA
Mailing Address - Street 2:
Mailing Address - City:MORATUWA
Mailing Address - State:MORATUWA
Mailing Address - Zip Code:10400
Mailing Address - Country:LK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DANBURY HOSPITAL 24 AVENUE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-8105
Practice Address - Fax:203-749-9092
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2023-03-13
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-03-13
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program