Healthcare Provider Details

I. General information

NPI: 1740294313
Provider Name (Legal Business Name): MURALI DHARAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. VISVANATHAN MURALIDHARAN

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3238
  • Fax: 860-679-0161
Mailing address:
  • Phone: 860-679-3238
  • Fax: 860-679-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number044072
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number044072
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: