Provider Demographics
NPI:1780872481
Name:PUTHUVEL, SHAJI JUSTUS (MD)
Entity type:Individual
Prefix:DR
First Name:SHAJI
Middle Name:JUSTUS
Last Name:PUTHUVEL
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 2197
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-2197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012482222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry