Provider Demographics
NPI:1689623621
Name:SOLOMON-BERGEN, PEGGY A (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:SOLOMON-BERGEN
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 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-567-1169
Practice Address - Street 1:1301 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7247
Practice Address - Country:US
Practice Address - Phone:609-572-0000
Practice Address - Fax:609-572-0039
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA044221002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K2671OtherPHS
1949826OtherUNITED HEALTH CARE
NJATP053OtherOXFORD
NJ0394434000OtherAMERIHEALTH HMO/PPO
NJ7850905Medicaid
NJ464751OtherAETNA PPO
NJATP053OtherOXFORD