Healthcare Provider Details

I. General information

NPI: 1659438026
Provider Name (Legal Business Name): LUDMILLA L TONKONOGY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PLANTATION ST
WORCESTER MA
01604-3023
US

IV. Provider business mailing address

21 WACHUSETT VIEW DR
WESTBOROUGH MA
01581-2647
US

V. Phone/Fax

Practice location:
  • Phone: 508-849-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59561
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number59561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: