Provider Demographics
NPI:1740246347
Name:BOLEN, SHARI DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:DANIELLE
Last Name:BOLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:DANIELLE
Other - Last Name:GOLDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:RAMMELKAMP RESEARCH & EDUC. BLDG, R221
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:METROHEALTH MEDICAL CENTER-INTERNAL MEDICINE CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH092468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402798100Medicaid
MD402798100Medicaid
MDH90453Medicare UPIN