Provider Demographics
NPI:1538144829
Name:SOLISH, ALFRED MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:MARC
Last Name:SOLISH
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 1:630 S RAYMOND AVE
Mailing Address - Street 2:230
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3283
Mailing Address - Country:US
Mailing Address - Phone:626-577-1115
Mailing Address - Fax:
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:230
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3283
Practice Address - Country:US
Practice Address - Phone:626-577-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42828207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G428282Medicaid
CAA92369Medicare UPIN
G42828CMedicare ID - Type Unspecified
G42828AMedicare ID - Type Unspecified
G42828BMedicare ID - Type Unspecified
CA00G428282Medicaid