Provider Demographics
NPI:1598728396
Name:PUTMAN, DONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:349 EAST NORTHFIELD ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4807
Mailing Address - Country:US
Mailing Address - Phone:973-597-3333
Mailing Address - Fax:973-597-3334
Practice Address - Street 1:349 EAST NORTHFIELD ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4807
Practice Address - Country:US
Practice Address - Phone:973-597-3333
Practice Address - Fax:973-597-3334
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA062219002080P0202X
NY1896372080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1644540Medicaid
NJ06914004Medicaid
NJG24616Medicare UPIN