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DR. MABODAWILAGE GANGA HEMATILLAKE MD
>> Internal Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1407967821
Individual Registrant:DR. MABODAWILAGE GANGA HEMATILLAKE MD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
650 S ZEDIKER AVE PARLIER, CA 93648 US
Tel: 559-646-3561 Fax: 559-646-6617
Tel: 559-646-3561 Fax: 559-646-6617
Contact information for business:
650 S ZEDIKER AVE PARLIER, CA 93648-2666 US
Tel: 559-646-3561 Fax: 559-646-6617
Tel: 559-646-3561 Fax: 559-646-6617
Registration Information:
NPI: 1407967821
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207R00000X | Allopathic & Osteopathic Physicians Internal Medicine | UT | 379576-1205 |
| N | 207R00000X | Allopathic & Osteopathic Physicians Internal Medicine | ID | M8520 |
| N | 207R00000X | Allopathic & Osteopathic Physicians Internal Medicine | PA | MD428463 |
| Y | 207R00000X | Allopathic & Osteopathic Physicians Internal Medicine | CA | C149813 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
