Provider Demographics
NPI:1902864374
Name:SOLOMON, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3698 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7015
Mailing Address - Country:US
Mailing Address - Phone:540-951-6070
Mailing Address - Fax:540-951-6071
Practice Address - Street 1:3698 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7015
Practice Address - Country:US
Practice Address - Phone:540-951-6070
Practice Address - Fax:540-951-6071
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902864374Medicaid
VAE43082Medicare UPIN
VA1902864374Medicaid