Provider Demographics
NPI:1073672531
Name:ALAHAKOON, ALEX T (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:T
Last Name:ALAHAKOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRABHU
Other - Middle Name:T
Other - Last Name:ALAHAKOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6275 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1504
Mailing Address - Country:US
Mailing Address - Phone:614-861-0967
Mailing Address - Fax:614-861-0930
Practice Address - Street 1:6275 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1504
Practice Address - Country:US
Practice Address - Phone:614-861-0967
Practice Address - Fax:614-861-0930
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAL4133212Medicare PIN
OHAL4133211Medicare PIN