1255725552 NPI number — REBECCA THOMSON PUTNAM MD

Table of content: REBECCA THOMSON PUTNAM MD (NPI 1255725552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255725552 NPI number — REBECCA THOMSON PUTNAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTNAM
Provider First Name:
REBECCA
Provider Middle Name:
THOMSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMSON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255725552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 HENDERSONVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-2868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-771-4223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 HENDERSONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-258-0608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2016-02014 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)