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General NPI Number Information
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NPI Number | 1073627600
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Entity Type | Individual
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Provider Name | ROENGSAK TULATHIMUTTE MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 575 BEECH ST ANESTHESIA DEPT
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City | HOLYOKE
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State | MA
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Zip | 01040-2223
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Country | US
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Telephone | 413-534-2845
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Fax |
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Provider Business Mailing Address
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Address Line | 22 S SYCAMORE KNLS
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City | SOUTH HADLEY
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State | MA
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Zip | 01075-1112
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Country | US
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Telephone | 413-534-8985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 47834
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License Number State | MA
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