Provider Demographics
NPI:1033139464
Name:SOLIS, PEDRO A (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:SOLIS
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 1:80 HAZLET AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1600
Mailing Address - Country:US
Mailing Address - Phone:732-739-5222
Mailing Address - Fax:732-739-3983
Practice Address - Street 1:80 HAZLET AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1600
Practice Address - Country:US
Practice Address - Phone:732-739-5222
Practice Address - Fax:732-739-3983
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03313800208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
D96517Medicare UPIN
S0142347Medicare ID - Type Unspecified