Provider Demographics
NPI:1629055710
Name:SOLANO, MILDRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:
Last Name:SOLANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HEMPSTEAD TPKE
Mailing Address - Street 2:PRIMARY HEALTHCARE PLUS
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1538
Mailing Address - Country:US
Mailing Address - Phone:516-352-8300
Mailing Address - Fax:516-352-8331
Practice Address - Street 1:1209 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1537
Practice Address - Country:US
Practice Address - Phone:516-352-8300
Practice Address - Fax:516-352-8331
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136396OtherGHI
11178218OtherCAQH
000207730201OtherHEALTHPLUS
3038133OtherAETNA
1000039787OtherAFFINITY
167323POtherHIP
P2706100OtherOXFORD
NY223117OtherLICENSE
3C5962OtherHEALTHNET
5295A1OtherEMPIRE BC/BS
N94176OtherGUARDIAN
223117B71OtherHEALTHFIRST
2250602OtherUNITED HEALTHCARE
040426010123OtherFIDELIS
NYWJW871OtherMEDICARE GROUP
NY02333466Medicaid
2475022006OtherCIGNA
NYBS7738670OtherDEA
11178218OtherCAQH
NY02333466Medicaid