Provider Demographics
NPI:1548220619
Name:PUTTERMAN, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:PUTTERMAN
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 1:15825 BALLANTYNE MEDICAL PL STE 240
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4790
Mailing Address - Country:US
Mailing Address - Phone:704-544-5245
Mailing Address - Fax:
Practice Address - Street 1:860 SUMMIT CROSSING PL STE 120
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2217
Practice Address - Country:US
Practice Address - Phone:740-861-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24284208D00000X
NCAP9426772202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2323842OtherGROUP MEDICARE PTAN
NCDE0112OtherGROUP MEDICARE RAILROAD PTAN
NC37011930OtherMEDICARE RAILROAD PTAN
NC37011930OtherMEDICARE RAILROAD PTAN
NCDE0112OtherGROUP MEDICARE RAILROAD PTAN