Provider Demographics
NPI:1093894487
Name:SOLOV, MARTIN D (PA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:SOLOV
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7901
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326894OtherCIGNA
CA5857607OtherAETNA
CAPA10056OtherBLUE CROSS
CA461162OtherINTERPLAN
CA1669350OtherUNITED HEALTHCARE
CA1750504OtherGREAT WEST
CA90143491OtherPACIFICARE
CA461162OtherINTERPLAN
CA0PA100560Medicare ID - Type Unspecified