Provider Demographics
NPI:1033142492
Name:PUTNAM CARDIOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PUTNAM CARDIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:-
Authorized Official - Last Name:MAHENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACC
Authorized Official - Phone:860-928-3958
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017690207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1176908Medicaid
CTB38503Medicare UPIN