Provider Demographics
NPI:1912647900
Name:SAMARASINGHE KANKANAMGE, LAKMAL SANJEEWA (MBBS)
Entity type:Individual
Prefix:DR
First Name:LAKMAL
Middle Name:SANJEEWA
Last Name:SAMARASINGHE KANKANAMGE
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FRAZER FIR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1658
Mailing Address - Country:US
Mailing Address - Phone:860-371-1115
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6077
Practice Address - Country:US
Practice Address - Phone:203-739-8105
Practice Address - Fax:203-749-9092
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT80655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program