Healthcare Provider Details

I. General information

NPI: 1962389759
Provider Name (Legal Business Name): LINGANATHA ANIL ADISESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE DEPT OF
FARMINGTON CT
06030-0002
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-8619
  • Fax:
Mailing address:
  • Phone: 860-679-2893
  • Fax: 860-679-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number79730
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: