Healthcare Provider Details

I. General information

NPI: 1346570975
Provider Name (Legal Business Name): ROMINA TOLLERUTTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 LEXINGTON AVE
MISSOULA MT
59808-5665
US

IV. Provider business mailing address

4024 LEXINGTON AVE
MISSOULA MT
59808-5665
US

V. Phone/Fax

Practice location:
  • Phone: 347-610-2634
  • Fax:
Mailing address:
  • Phone: 347-610-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number266037
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number266037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: