Provider Demographics
NPI:1992775993
Name:PUTNAM, JARED (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1255
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:240-483-0075
Mailing Address - Fax:240-483-0242
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1255
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:240-483-0075
Practice Address - Fax:240-483-0242
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00598062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH58149Medicare UPIN