=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629150974
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARTIK K VISWANATHAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 12/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 WASHINGTON ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-8331
-----------------------------------------------------
Fax | 860-892-6926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 606 WEST MAIN STREET
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-1400
-----------------------------------------------------
Fax | 860-889-3163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 035789
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------