Provider Demographics
NPI:1053305441
Name:PUTNAM MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:PUTNAM MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-928-2736
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0926
Mailing Address - Country:US
Mailing Address - Phone:860-928-2736
Mailing Address - Fax:860-928-6867
Practice Address - Street 1:330 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1854
Practice Address - Country:US
Practice Address - Phone:860-928-2736
Practice Address - Fax:860-928-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty