Provider Demographics
NPI:1962459156
Name:WALGAMPAYA, DAKSHINA N B (MD)
Entity Type:Individual
Prefix:DR
First Name:DAKSHINA
Middle Name:N B
Last Name:WALGAMPAYA
Suffix:
Gender:M
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:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-8927
Mailing Address - Fax:813-844-4705
Practice Address - Street 1:2501 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3305
Practice Address - Country:US
Practice Address - Phone:813-844-1385
Practice Address - Fax:813-254-0230
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433531207R00000X
ND9827207R00000X
FLME121730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003151OtherFIRST PRIORITY HEALTH
PA1021818390001Medicaid
ND24943OtherBCBS ELGIN CLINIC
ND25272OtherBCBS HEBRON CLINIC
PA2899231OtherUNITEDHEALTHCARE
ND13241Medicaid
PA2042683OtherHIGHMARK BLUE SHIELD
FL015208700Medicaid
PA7190743OtherAETNA
PA2899231OtherUNITEDHEALTHCARE
FL015208700Medicaid
PA7190743OtherAETNA
ND24943OtherBCBS ELGIN CLINIC