Individual
BHOOWIT LERTTIENDAMRONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 282-3894
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(773) 564-5225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.086759
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CT
Other
Enumeration date
07/11/2025
Last updated
02/12/2026
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