Provider Demographics
NPI:1932724549
Name:MAHENDHAR, RUPAK (MBBS)
Entity Type:Individual
Prefix:MR
First Name:RUPAK
Middle Name:
Last Name:MAHENDHAR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5643
Mailing Address - Country:US
Mailing Address - Phone:917-655-8442
Mailing Address - Fax:
Practice Address - Street 1:2731 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5235
Practice Address - Country:US
Practice Address - Phone:205-349-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-08-08
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-08
Provider Licenses
StateLicense IDTaxonomies
AL45955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics