Provider Demographics
NPI:1558381137
Name:SOLOMON, YOUSSEF N (MD)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:N
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 1:1520 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2036
Mailing Address - Country:US
Mailing Address - Phone:701-352-0818
Mailing Address - Fax:
Practice Address - Street 1:STATE DEVELOPMENTAL CENTER, WEST 6TH STREET
Practice Address - Street 2:GRAFTON VA CLINIC
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2036
Practice Address - Country:US
Practice Address - Phone:701-352-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist