Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 51376 | CT |
N | 207RH0003X | Hematology & Oncology | 33037 | DC |
NPI | 1154307866 |
---|---|
Provider Name | Dr. Andrew Tyler Putnam |
First Address | New Haven, CT 06520-8028 |
Second Address | New Haven, CT 06510-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 17/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080176087 | RAILROAD MEDICARE (01) | DC |
G91731 | (02) |