Provider Demographics
NPI:1114952116
Name:KAMALIAN, SHOLEH (MD)
Entity Type:Individual
Prefix:MS
First Name:SHOLEH
Middle Name:
Last Name:KAMALIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:MIDSTATE MEDICAL CENTER
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451
Practice Address - Country:US
Practice Address - Phone:203-284-1340
Practice Address - Fax:203-265-4557
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09017400207R00000X
CT043872207R00000X, 208M00000X
MA253860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043872OtherCONNECTICARE
CT2V6574OtherHEALTHNET
CT010043872CT01OtherBC
I50432Medicare UPIN