MEDICARE: DR. ROMINA TOLLERUTTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	266037	NY
2	208000000X	Pediatrics Physician	266037	NY

General Provider Information

NPI Number	:	1346570975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMINA TOLLERUTTI M.D.

Provider Business Mailing Address
First Line	:	4024 LEXINGTON AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-5665
Country	:	US
Telephone Number	:	347-610-2634
Fax Number	:

Provider Business Practice Location Address
First Line	:	4024 LEXINGTON AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-5665
Country	:	US
Telephone Number	:	347-610-2634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	06/12/2023

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