Individual
VAIKOM MAHADEVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3452
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
1013672
MA
207RI0011X
Interventional Cardiology Physician
Primary
1013672
MA
Other
Enumeration date
08/11/2014
Last updated
05/08/2023
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