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General NPI Number Information
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NPI Number | 1548220619
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Entity Type | Individual
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Provider Name | PAUL S PUTTERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 860 SUMMIT CROSSING PL STE 120
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City | GASTONIA
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State | NC
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Zip | 28054-2217
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Country | US
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Telephone | 740-861-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 15825 BALLANTYNE MEDICAL PL STE 240
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City | CHARLOTTE
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State | NC
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Zip | 28277-4790
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Country | US
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Telephone | 704-544-5245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 24284
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | AP9426772
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License Number State | NC
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