Healthcare Provider Details

I. General information

NPI: 1275548075
Provider Name (Legal Business Name): ROMAN K TUSINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMPSON RD SUITE 108
WEBSTER MA
01570-1509
US

IV. Provider business mailing address

340 THOMPSON RD SUITE 108
WEBSTER MA
01570-1509
US

V. Phone/Fax

Practice location:
  • Phone: 508-943-5132
  • Fax: 508-943-5209
Mailing address:
  • Phone: 508-943-5132
  • Fax: 508-943-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number250351
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: