Provider Demographics
NPI:1629746052
Name:SOLOMON, ZACK COSGROVE (OD)
Entity Type:Individual
Prefix:DR
First Name:ZACK
Middle Name:COSGROVE
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 SAVAGE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4620
Mailing Address - Country:US
Mailing Address - Phone:240-412-5721
Mailing Address - Fax:
Practice Address - Street 1:1029 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4017
Practice Address - Country:US
Practice Address - Phone:410-752-8208
Practice Address - Fax:410-752-7144
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist