Provider Demographics
NPI:1356636146
Name:WALGAMA, ALISON L (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:WALGAMA
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 1:805 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5130
Mailing Address - Country:US
Mailing Address - Phone:903-232-8100
Mailing Address - Fax:903-232-8115
Practice Address - Street 1:805 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5130
Practice Address - Country:US
Practice Address - Phone:903-232-8100
Practice Address - Fax:903-232-8115
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2393207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350266803Medicaid