Provider Demographics
NPI:1700448669
Name:MAHENDIRAN, SAGANA
Entity Type:Individual
Prefix:
First Name:SAGANA
Middle Name:
Last Name:MAHENDIRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K9J 7C6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:ONTARIO
Practice Address - Zip Code:K9J 7C6
Practice Address - Country:CA
Practice Address - Phone:513-970-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301507445207Q00000X
MI4351044775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine