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NPI Code Detail

MEDICARE: BHOOWIT LERTTIENDAMRONG

MEDICARE: BHOOWIT LERTTIENDAMRONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCT

General Provider Information

NPI Number : 1396636965
Entity Type Code : Individual
Provider Name (Legal Business Name) : BHOOWIT LERTTIENDAMRONG
Provider Business Mailing Address
First Line : 263 FARMINGTON AVE
Second Line :
City : FARMINGTON
State : CT
Zip : 06030-0001
Country : US
Telephone Number : 773-564-5225
Fax Number :
Provider Business Practice Location Address
First Line : 263 FARMINGTON AVE
Second Line :
City : FARMINGTON
State : CT
Zip : 06030-0001
Country : US
Telephone Number : 860-282-3894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2025
Last Update Date : 02/12/2026

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Directions to “ BHOOWIT LERTTIENDAMRONG ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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