Healthcare Provider Details

I. General information

NPI: 1306969282
Provider Name (Legal Business Name): SAILAJA PUTTAGUNTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST
WATERBURY CT
06706-1221
US

IV. Provider business mailing address

39 BUELL HILL RD
KILLINGWORTH CT
06419-1315
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-6000
  • Fax:
Mailing address:
  • Phone: 860-661-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036200
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: