Healthcare Provider Details

I. General information

NPI: 1497876643
Provider Name (Legal Business Name): RONALD R LEOMBRUNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 GRANBY RD STE 1
SOUTH HADLEY MA
01075-3218
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-3926
  • Fax: 413-794-8732
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: