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General NPI Number Information
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NPI Number | 1558652180
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Entity Type | Organization
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Legal Business Name | U.S.WALGAMA MD PA
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Dates
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Enumeration Date | 04/30/2011
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 321 WILSON ST
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City | HENDERSON
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State | TX
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Zip | 75652-5957
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Country | US
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Telephone | 903-658-4349
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Fax |
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Provider Business Mailing Address
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Address Line | 321 WILSON ST
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City | HENDERSON
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State | TX
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Zip | 75652-5957
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Country | US
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Telephone | 903-658-4349
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | UPALI S WALGAMA
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Credential | MD
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Telephone | 903-658-4349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | F0066
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License Number State | TX
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