Provider Demographics
NPI:1588664833
Name:SOLOMON, SUSAN (M)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3525
Mailing Address - Country:US
Mailing Address - Phone:419-843-3627
Mailing Address - Fax:419-843-9697
Practice Address - Street 1:4411 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3525
Practice Address - Country:US
Practice Address - Phone:419-843-3627
Practice Address - Fax:419-843-9697
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058006S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2088084Medicaid
OHSO0860572Medicare PIN
OHE07233Medicare UPIN
OHH005980Medicare PIN