Provider Demographics
NPI:1285672030
Name:SOLOMON, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:SOLOMON
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 1:25 MONUMENT ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:717-851-2444
Practice Address - Street 1:25 MONUMENT ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-851-2444
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024836E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01843301OtherCAPITAL BLUE CROSS
PA001051274Medicaid
PA0463334OtherHIGHMARK BLUE SHIELD
PA060013260OtherRAILROAD MEDICARE PIN
PA01843301OtherCAPITAL BLUE CROSS
C34408Medicare UPIN