Provider Demographics
NPI:1568452159
Name:SHOLOMSKAS, ALAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JAMES
Last Name:SHOLOMSKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITNEY AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1220
Mailing Address - Country:US
Mailing Address - Phone:203-776-2077
Mailing Address - Fax:203-782-3795
Practice Address - Street 1:2 WHITNEY AVE
Practice Address - Street 2:STE 204
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1220
Practice Address - Country:US
Practice Address - Phone:203-776-2077
Practice Address - Fax:203-782-3795
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0176492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83333Medicare UPIN
260000564Medicare ID - Type Unspecified