Provider Demographics
NPI:1588190433
Name:MATUROSTRAKUL, BOONYANUTH (MD)
Entity Type:Individual
Prefix:MS
First Name:BOONYANUTH
Middle Name:
Last Name:MATUROSTRAKUL
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:RENAL & TRANSPLANT ASSOCIATES OF NEW ENGLAND, P.C.
Mailing Address - Street 2:100 WASON AVE STE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1179
Mailing Address - Country:US
Mailing Address - Phone:413-733-9666
Mailing Address - Fax:413-750-3432
Practice Address - Street 1:RENAL & TRANSPLANT ASSOCIATES OF NEW ENGLAND, P.C.
Practice Address - Street 2:100 WASON AVE STE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1179
Practice Address - Country:US
Practice Address - Phone:413-733-9666
Practice Address - Fax:413-750-3432
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-09-07
Deactivation Date:2017-12-20
Deactivation Code:
Reactivation Date:2017-12-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA1013403207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program