Provider Demographics
NPI:1154352516
Name:MAHENDRAN, ALEXANDER - (MD,FACC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:-
Last Name:MAHENDRAN
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1800
Mailing Address - Country:US
Mailing Address - Phone:860-928-3958
Mailing Address - Fax:860-928-2052
Practice Address - Street 1:158 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1800
Practice Address - Country:US
Practice Address - Phone:860-928-3958
Practice Address - Fax:860-928-2052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017690207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease