Healthcare Provider Details

I. General information

NPI: 1548220619
Provider Name (Legal Business Name): PAUL S PUTTERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 SUMMIT CROSSING PL STE 120
GASTONIA NC
28054-2217
US

IV. Provider business mailing address

15825 BALLANTYNE MEDICAL PL STE 240
CHARLOTTE NC
28277-4790
US

V. Phone/Fax

Practice location:
  • Phone: 740-861-2072
  • Fax:
Mailing address:
  • Phone: 704-544-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24284
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberAP9426772
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: