Provider Demographics
NPI:1134185242
Name:SOLOMON, DALE E (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:E
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4602
Mailing Address - Country:US
Mailing Address - Phone:423-392-6000
Mailing Address - Fax:423-392-6030
Practice Address - Street 1:1916 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4602
Practice Address - Country:US
Practice Address - Phone:423-392-6000
Practice Address - Fax:423-392-6030
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD07021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134185242Medicaid
TN110183641OtherRAILROAD MEDICARE
TN2001223OtherBCBS
TNTN01K6OtherJOHN DEERE
TN3160714Medicaid
TNQ003316Medicaid
TN3160710Medicare PIN