Provider Demographics
NPI:1689831240
Name:MARTIN D SOLOMON MD PA
Entity Type:Organization
Organization Name:MARTIN D SOLOMON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-481-8100
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3584
Mailing Address - Country:US
Mailing Address - Phone:817-481-8100
Mailing Address - Fax:817-421-6112
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 470
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3584
Practice Address - Country:US
Practice Address - Phone:817-481-8100
Practice Address - Fax:817-421-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH88452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194541201Medicaid
TXDH2391OtherRRMEDICARE
TX0035RJOtherBCBS
TX194541201Medicaid
TXDH2391OtherRRMEDICARE