Healthcare Provider Details

I. General information

NPI: 1851385991
Provider Name (Legal Business Name): DON WALTER KANNANGARA M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BRIDLE PATH PL
BETHLEHEM PA
18017-3804
US

IV. Provider business mailing address

2750 BRIDLE PATH PL
BETHLEHEM PA
18017-3804
US

V. Phone/Fax

Practice location:
  • Phone: 610-778-2154
  • Fax: 610-317-9449
Mailing address:
  • Phone: 610-778-2154
  • Fax: 610-317-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD019081E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: