Healthcare Provider Details

I. General information

NPI: 1457426934
Provider Name (Legal Business Name): PULMONARY PHYSICIANS OF NORWICH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WAWECUS ST STE 103
NORWICH CT
06360-2173
US

IV. Provider business mailing address

79 WAWECUS ST STE 103
NORWICH CT
06360-2173
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-1862
  • Fax: 860-886-2046
Mailing address:
  • Phone: 860-886-1862
  • Fax: 860-886-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THINESH DAHANAYAKE
Title or Position: PRESIDENT
Credential: MD
Phone: 860-886-1862