1619184835 NPI number — MRS. SHEA W PUTTKAMMER MD

Table of content: MRS. SHEA W PUTTKAMMER MD (NPI 1619184835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619184835 NPI number — MRS. SHEA W PUTTKAMMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTTKAMMER
Provider First Name:
SHEA
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619184835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 BROWNS HILL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-272-2702
Provider Business Mailing Address Fax Number:
804-272-9355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7650 E, PARHAM RD MOB11
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-272-2702
Provider Business Practice Location Address Fax Number:
804-747-9050
Provider Enumeration Date:
05/17/2007

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: 207RE0101X , with the licence number:  0101242441 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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