Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Ilham Derhan Putra, MD

Individual provider Anatomic Pathology & Clinical Pathology Physician · NPI 1770110389

Ilham Derhan Putra, MD practises Pathology in Flushing, New York. Qualified in 2013, 13 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in New York.

Years since qualifying
13
Licensed in
NY
In the registry since
2020
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5645 Main St
Flushing, NY 11355-5045
Phone: (718) 670-1374
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 525 E 68th St, New York, NY 10065-4870 — (813) 789-3508

Specialties & licences

Anatomic Pathology & Clinical Pathology Physician (primary) Taxonomy 207ZP0102X · Licence 337333 (NY)

Record details

NPI number1770110389
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 24, 2020
Last updated in NPPESOctober 14, 2026
Certification dateOctober 14, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPATHOLOGY
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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