Healthcare Provider Details

I. General information

NPI: 1760447288
Provider Name (Legal Business Name): THEODORE INMAN PUTNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

4511 HARLEM ROAD SUITE 202
AMHERST NY
14226-3822
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7109
  • Fax: 716-888-3874
Mailing address:
  • Phone: 716-839-6720
  • Fax: 716-839-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number095973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: