Provider Demographics
NPI:1770680357
Name:SOLOMON, JEFFREY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2241
Mailing Address - Country:US
Mailing Address - Phone:216-371-1497
Mailing Address - Fax:
Practice Address - Street 1:6131 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1627
Practice Address - Country:US
Practice Address - Phone:718-387-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002080S213E00000X
NYN003492-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0503164Medicaid
NY00740987Medicaid
OHT51089Medicare UPIN
NYP362609771Medicare PIN