MEDICARE: THORONAGE HN KANKANAM GAMAGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	231395	MA

General Provider Information

NPI Number	:	1912118894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THORONAGE HN KANKANAM GAMAGE MD

Provider Business Mailing Address
First Line	:	2121 PAULDING AVE APT 3J
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 SOUTH ST
Second Line	:
City	:	WARE
State	:	MA
Zip	:	01082-1660
Country	:	US
Telephone Number	:	413-967-2532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	12/22/2021

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