Provider Demographics
NPI:1154307866
Name:PUTNAM, ANDREW TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TYLER
Last Name:PUTNAM
Suffix:
Gender:M
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:PO BOX 208028
Mailing Address - Street 2:333 CEDAR STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8028
Mailing Address - Country:US
Mailing Address - Phone:203-737-4353
Mailing Address - Fax:203-785-3712
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-737-4353
Practice Address - Fax:203-785-3712
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51376207RH0002X
DC33037207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC080176087OtherRAILROAD MEDICARE
DC007951G93Medicare PIN
DC080176087OtherRAILROAD MEDICARE