Healthcare Provider Details

I. General information

NPI: 1992775993
Provider Name (Legal Business Name): JARED PUTNAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE SUITE 1255
CHEVY CHASE MD
20815-4404
US

IV. Provider business mailing address

5530 WISCONSIN AVE SUITE 1255
CHEVY CHASE MD
20815-4404
US

V. Phone/Fax

Practice location:
  • Phone: 240-483-0075
  • Fax: 240-483-0242
Mailing address:
  • Phone: 240-483-0075
  • Fax: 240-483-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0059806
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: