Marshall Edward Putnam, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

103249 Issued in NC

Practice address

217 Glensford Dr
Fayetteville, NC 28314-0892

Phone

(910) 483-4647

Fax

(910) 483-6431

NPI assigned

May 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Pittsboro Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Pittsboro, NC
  • NPI 1699052613
  NPD
• Clayton Urgent Care and Family Clinic PA

  • General Practice Physician
  • Clayton, NC
  • NPI 1104912096
  NPD (past)
• United Emergency Services, Inc.

  • Emergency Medicine Physician
  • Booneville, MS
  • NPI 1326007915

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1962459404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 RUTH CIR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275264209",
            "telephone_number": "919-818-4755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 GLENSFORD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283140892",
            "telephone_number": "910-483-4647",
            "fax_number": "910-483-6431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1705 Tarboro St SW",
            "address_purpose": "LOCATION",
            "city": "Wilson",
            "state": "NC",
            "postal_code": "278933428",
            "country_code": "US",
            "telephone_number": "252-399-8040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "MARSHALL",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103249",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102360",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Purple Paws, PLLC
• Purpose Driven Support Services LLC
• Ryan Pursley, DO
• Ravi Vishram Purushuttam, M.D.
• Claire Anderson Puryear, LPCA, MED
• Julie Puzzo, DO
• Jamie Pyle, LCMHCA
• Donna C Pyles, LCSW
• Pynokul Therapeutic and Developmental Services, LLC
• Ayema Bint Qadir, DMD

• Medical Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.