Provider Demographics
NPI:1457321630
Name:SOLOWAY, EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:SOLOWAY
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:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-0107
Mailing Address - Country:US
Mailing Address - Phone:781-729-4455
Mailing Address - Fax:781-229-4831
Practice Address - Street 1:220 SWANTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1921
Practice Address - Country:US
Practice Address - Phone:781-729-4455
Practice Address - Fax:781-229-4831
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1452213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0382774Medicaid
MA33187OtherPILGRIM
MAY70582Medicare ID - Type Unspecified