Provider Demographics
NPI:1508805862
Name:SOLOMON, MARCUS JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:JOEL
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207
Mailing Address - Country:US
Mailing Address - Phone:615-860-5773
Mailing Address - Fax:615-860-1542
Practice Address - Street 1:2010 CHURCH STREET
Practice Address - Street 2:SUITE 603
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-284-5755
Practice Address - Fax:615-284-5759
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036088310174400000X
TN0000045107174400000X
KYTP935174400000X
TNMD0000045107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201714OtherBCBS
IL180026814OtherRR MEDICARE PIN
IL36088310Medicaid
ILF77455Medicare UPIN
IL2201714OtherBCBS