Healthcare Provider Details

I. General information

NPI: 1295161107
Provider Name (Legal Business Name): HARESH K VISWESHWAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-0002
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4450
  • Fax:
Mailing address:
  • Phone: 860-679-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14063A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL6788
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number057389
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: