Provider Demographics
NPI:1346570975
Name:TOLLERUTTI, ROMINA (MD)
Entity type:Individual
Prefix:DR
First Name:ROMINA
Middle Name:
Last Name:TOLLERUTTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5665
Mailing Address - Country:US
Mailing Address - Phone:347-610-2634
Mailing Address - Fax:
Practice Address - Street 1:4024 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5665
Practice Address - Country:US
Practice Address - Phone:347-610-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2660372083B0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine