Individual
ROENGSAK TULATHIMUTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
575 BEECH ST, ANESTHESIA DEPT, HOLYOKE, MA 01040-2223
(413) 534-2845
Mailing address
22 S SYCAMORE KNLS, SOUTH HADLEY, MA 01075-1112
(413) 534-8985
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
47834
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HX4518
MEDICARE ID
MA
Enumeration date
08/19/2006
Last updated
08/15/2008
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