Individual
THOMAS ALAN PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 W FAIRMOUNT AVE, LAKEWOOD, NY 14750-1702
(716) 338-0033
Mailing address
20 W FAIRMOUNT AVE, LAKEWOOD, NY 14750-1702
(716) 338-0033
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
154630
NY
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
154630-2
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00639487
—
NY
01
—
J400082246
PTAN
—
Enumeration date
03/27/2007
Last updated
12/13/2019
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