Provider Demographics
NPI:1457318651
Name:SOLTYS, GRACE REGINA (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:REGINA
Last Name:SOLTYS
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 1:1802 STONECREST CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-5524
Mailing Address - Country:US
Mailing Address - Phone:804-674-9207
Mailing Address - Fax:
Practice Address - Street 1:3602 MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4905
Practice Address - Country:US
Practice Address - Phone:804-358-4904
Practice Address - Fax:804-358-3107
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006728952Medicaid