Provider Demographics
NPI:1306969282
Name:PUTTAGUNTA, SAILAJA (MD)
Entity type:Individual
Prefix:DR
First Name:SAILAJA
Middle Name:
Last Name:PUTTAGUNTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BUELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1315
Mailing Address - Country:US
Mailing Address - Phone:860-661-0634
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1221
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036200207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010036200CT02OtherANTHEM BCBS CT
CT7524439OtherAETNA
CT036200OtherCONNECTICARE
CT3V2508OtherHEALTHNET/COMMERCIAL
CTP2836618OtherOXFORD
CT001362003Medicaid
CT190433OtherWELLCARE
CT890656OtherUSA
CT22-98866OtherAMERICHOICE
CT22-98866OtherUHC
CT190433OtherWELLCARE
CT010036200CT02OtherANTHEM BCBS CT