Provider Demographics
NPI:1265577175
Name:WALGAMA, UPALI SANATH (MD)
Entity type:Individual
Prefix:
First Name:UPALI
Middle Name:SANATH
Last Name:WALGAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-3133
Mailing Address - Country:US
Mailing Address - Phone:903-392-8259
Mailing Address - Fax:
Practice Address - Street 1:105 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-3133
Practice Address - Country:US
Practice Address - Phone:903-392-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BT79Medicare ID - Type Unspecified