Provider Demographics
NPI:1467665364
Name:SOLOMON, JEFFREY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
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 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-4440
Mailing Address - Fax:330-543-4467
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4440
Practice Address - Fax:330-543-4467
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091861208000000X
OH35-091861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3600271OtherMEDICARE GROUP #
OH4263361Medicare PIN
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH1821035940OtherAGMC TYPE 2 NPI #
OH0454744OtherMEDICAID GROUP #
OH2962316Medicaid
OHH119971Medicare PIN