Provider Demographics
NPI:1578556486
Name:BALI, SHAMMI K (MD)
Entity type:Individual
Prefix:
First Name:SHAMMI
Middle Name:K
Last Name:BALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:206 TALCOTTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4617
Mailing Address - Country:US
Mailing Address - Phone:860-645-1100
Mailing Address - Fax:860-533-0041
Practice Address - Street 1:206 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4617
Practice Address - Country:US
Practice Address - Phone:860-645-1100
Practice Address - Fax:860-533-0041
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT83043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30036OtherBLUE CROSS BLUE SHIELD
FLU2421QMedicare PIN
FLP01288909OtherRAILROAD MEDICARE
FLU2421SMedicare PIN