Provider Demographics
NPI:1235257411
Name:SOLOMON, MARK P (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:191 PRESIDENTIAL BOULEVARD
Mailing Address - Street 2:SUITE LN24
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-667-7070
Mailing Address - Fax:610-664-6664
Practice Address - Street 1:191 PRESIDENTIAL BOULEVARD
Practice Address - Street 2:SUITE LN24
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-667-7070
Practice Address - Fax:610-664-6664
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-08-14
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Provider Licenses
StateLicense IDTaxonomies
PAMD023066E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C29149Medicare UPIN