Individual
DR. TILAK C GOONERATNE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
345 N MAIN ST, STE 248, WEST HARTFORD, CT 06117
(860) 231-8453
(860) 523-4061
Mailing address
345 N MAIN ST, STE 248, WEST HARTFORD, CT 06117
(860) 231-8453
(860) 523-4061
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
023723
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010023723CT02
ANTHEM BCBS
CT
01
—
021749
CONNECTICARE
CT
Enumeration date
03/14/2006
Last updated
07/08/2007
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