Provider Demographics
NPI:1306898259
Name:SHAMES, BRIAN D (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:SHAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT OFFICE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:GENERAL SURGERY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-6227
Practice Address - Country:US
Practice Address - Phone:860-679-8080
Practice Address - Fax:860-679-1420
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049264204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049264OtherCONNECTICARE
CT1306898259Medicaid
CT010049264CT02OtherANTHEM BC/BS
CT1306898259Medicaid
CTD400070661Medicare PIN