Provider Demographics
NPI:1518235431
Name:GHEBREGZIABIHER, SOLOMON T (MD)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:T
Last Name:GHEBREGZIABIHER
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 1:3609 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4457
Mailing Address - Country:US
Mailing Address - Phone:910-500-0909
Mailing Address - Fax:910-920-4224
Practice Address - Street 1:3609 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-500-0909
Practice Address - Fax:910-920-4224
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2012-01456OtherLICENSE
NCFG3369130OtherDEA