Provider Demographics
NPI:1003090291
Name:SOLIS PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:SOLIS PHYSICIANS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-487-4692
Mailing Address - Street 1:5800 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1737
Mailing Address - Country:US
Mailing Address - Phone:215-487-4692
Mailing Address - Fax:215-487-4274
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-487-4692
Practice Address - Fax:215-487-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005231L103TB0200X
PAOS013039207Q00000X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131304XYZMedicare PIN
PA108076Medicare PIN
PA193563XYZMedicare PIN
PA536568Q6BMedicare PIN