Healthcare Provider Details

I. General information

NPI: 1538270194
Provider Name (Legal Business Name): DANA W. PUTNAM M.ED., ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 HOWARD RD ODIA, US MILITARY ACADEMY
WEST POINT NY
10996-1510
US

IV. Provider business mailing address

639 HOWARD RD ODIA, US MILITARY ACADEMY
WEST POINT NY
10996-1510
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-2180
  • Fax: 845-938-3012
Mailing address:
  • Phone: 845-938-2180
  • Fax: 845-938-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000107-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: