Provider Demographics
NPI:1306116686
Name:KARISANKAPPA PUTTASWAMY, MOHAN (MBBS)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:KARISANKAPPA PUTTASWAMY
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:95 W SQUANTUM ST
Mailing Address - Street 2:111, ARCHSTONE QUINCY
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2123
Mailing Address - Country:US
Mailing Address - Phone:716-598-5664
Mailing Address - Fax:
Practice Address - Street 1:95 W SQUANTUM ST
Practice Address - Street 2:111, ARCHSTONE QUINCY
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2123
Practice Address - Country:US
Practice Address - Phone:716-598-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ31386207XP3100X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery