Provider Demographics
NPI:1407017429
Name:SOLTIS, LUCIA I (MD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:I
Last Name:SOLTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5885
Practice Address - Street 1:7400 LYNN AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523
Practice Address - Country:US
Practice Address - Phone:304-824-5806
Practice Address - Fax:304-824-5885
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV24336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022337Medicaid
WVWV0313BMedicare Oscar/Certification
WVWV0313B662Medicare Oscar/Certification
WV3810022337Medicaid
WVWV0313GMedicare Oscar/Certification
WVWV0313AMedicare PIN
WVWV0313B663Medicare Oscar/Certification
WVWV0313DMedicare Oscar/Certification
WVWV0313HMedicare Oscar/Certification
WVWV0313FMedicare Oscar/Certification
WVWV0313CMedicare Oscar/Certification