Provider Demographics
NPI:1558318733
Name:PUTNAM, SUZANNE E (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:PUTNAM-HORNBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SALTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15681-8985
Mailing Address - Country:US
Mailing Address - Phone:724-639-3541
Mailing Address - Fax:
Practice Address - Street 1:101 9TH ST
Practice Address - Street 2:
Practice Address - City:SALTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15681-8985
Practice Address - Country:US
Practice Address - Phone:724-639-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072221L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018438480001Medicaid
049331Medicare ID - Type Unspecified
401949Medicare PIN
H42267Medicare UPIN