Basic Information
| Provider Information | |||||||||
| NPI: | 1013178623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUTTICHANDA | ||||||||
| FirstName: | SHARATH | ||||||||
| MiddleName: | PONNAPPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 UNION ST | ||||||||
| Address2: | APARTMENT 610 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029031790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176751997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 BLACKSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556346 | ||||||||
| FaxNumber: | 4014556532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD13908 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.