NPIMap

Individual provider Active NPI

Raja Fattaleh, MD

  • Family Medicine Physician
  • Putnam, CT
National Provider Identifier
1841283439
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
038188 Issued in CT
Practice address
353 Pomfret St
Putnam, CT 06260-1835
Phone
(860) 928-1111
Fax
(860) 963-7756
NPI assigned
Aug 29, 2005
Last updated
Mar 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 038188 CT Primary

Addresses

Primary practice location

353 Pomfret St
Putnam, CT 06260-1835

Mailing address

PO Box 333
Putnam, CT 06260-0333
Phone (860) 928-1111

Other identifiers 1

IdentifierTypeStateIssuer
001381889MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040827000438 CT Practitioner - Family Practice 7517932106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

353 Pomfret St
Putnam, CT 06260-1835
Phone (860) 928-1111

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
038188CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Priority Family Healthcare of Northeast Connecticut, LLC Family Medicine CurrentSince Sep 1, 2009 Accepting new patients
Day Kimball Medical Group Inc Family Medicine CurrentSince Jan 1, 2013 Accepting new patients
Abington Family Healthcare, LLC Family Medicine Past Accepting new patients

Locations

132 Westminster Rd
Canterbury, CT 06331
Phone (860) 546-2225

612 Hartford Pike
Dayville, CT 06241
Phone (860) 779-0284

320 Pomfret St
Putnam, CT 06260
Phone (860) 963-6331

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1694/brand/19/csg/48/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1841283439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 333",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062600333",
            "telephone_number": "860-928-1111",
            "fax_number": "860-963-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 POMFRET ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601835",
            "telephone_number": "860-928-1111",
            "fax_number": "860-963-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATTALEH",
        "first_name": "RAJA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-29",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "038188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001381889",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Putnam, CT

Sources for this page

Verify at the official NPI Registry.