Provider Demographics
NPI:1063694438
Name:FONSEKA, JANAKI S (MD)
Entity type:Individual
Prefix:
First Name:JANAKI
Middle Name:S
Last Name:FONSEKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEMBUGE DONA
Other - Middle Name:JSN
Other - Last Name:FONSEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-2503
Mailing Address - Fax:603-740-2497
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:LEVEL 2
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2503
Practice Address - Fax:603-740-2497
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16006208M00000X
CT48274207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081217Medicaid
ME1063694438Medicaid
NHP01181513OtherRR MEDICARE
NH3081217Medicaid