Dr. Tilak C Gooneratne
Adolescent Medicine
345 N Main St Ste 248
West Hartford
, Connecticut 06117
Dr. Tilak C Gooneratne
Adolescent Medicine
345 N Main St Ste 248
West Hartford
, Connecticut 06117
(860) 523-4061
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. Tilak C Gooneratne
- 345 N Main St Ste 248
- West Hartford, CT
- Zip : 06117
- Fax : (860) 523-4061
- Phone : (860) 231-8453
Second Address
- Dr. Tilak C Gooneratne
- 345 N Main St Ste 248
- West Hartford, CT
- Zip : 06117
- Fax : (860) 523-4061
- Phone : (860) 231-8453
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | 023723 | CT |
National Provider Identifier
| NPI | 1265400329 |
|---|---|
| Provider Name | Dr. Tilak C Gooneratne |
| First Address | West Hartford, CT 06117 |
| Second Address | West Hartford, CT 06117 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/03/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 010023723CT02 | ANTHEM BCBS (01) | CT |
| 021749 | CONNECTICARE (01) | CT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.