Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 31386 | ZZ |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 31386 | ZZ |
NPI | 1306116686 |
---|---|
Provider Name | Mohan Karisankappa Puttaswamy |
First Address | Quincy, MA 02171-2123 |
Second Address | Quincy, MA 02171-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2012 |
Last Update Date | 20/03/2013 |