Provider Demographics
NPI:1639206931
Name:JOHN J. SOLOMON JR DO
Entity Type:Organization
Organization Name:JOHN J. SOLOMON JR DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:401-334-3331
Mailing Address - Street 1:2 WAKE ROBIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4241
Mailing Address - Country:US
Mailing Address - Phone:401-334-3331
Mailing Address - Fax:401-334-9000
Practice Address - Street 1:2 WAKE ROBIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4241
Practice Address - Country:US
Practice Address - Phone:401-334-3331
Practice Address - Fax:401-334-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty