Provider Demographics
NPI:1619082161
Name:SOLOMON, RICHARD JAY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAY
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 1:300 MARTEL LN
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7865
Mailing Address - Country:US
Mailing Address - Phone:802-310-6337
Mailing Address - Fax:
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:UHC 2309
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009375Medicaid
NY02354525Medicaid
VN3047Medicare ID - Type Unspecified
VT1009375Medicaid