MEDICARE: DR. DAKSHINA N B WALGAMPAYA MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD433531	PA
2	207R00000X	Internal Medicine Physician	9827	ND
3	207R00000X	Internal Medicine Physician	ME121730	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003151	OTHER	PA	FIRST PRIORITY HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	24943	OTHER	ND	BCBS ELGIN CLINIC
4	25272	OTHER	ND	BCBS HEBRON CLINIC
5	2899231	OTHER	PA	UNITEDHEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2042683	OTHER	PA	HIGHMARK BLUE SHIELD
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7190743	OTHER	PA	AETNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1962459156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAKSHINA N B WALGAMPAYA MD

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33601-1289
Country	:	US
Telephone Number	:	813-844-8927
Fax Number	:	813-844-4705

Provider Business Practice Location Address
First Line	:	2501 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3305
Country	:	US
Telephone Number	:	813-844-1385
Fax Number	:	813-254-0230

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	06/08/2021

3305 W KENNEDY BLVD
TAMPA, FL
33609-2903

Practice Phone: 813-875-6569
Practice Fax: 813-874-2889