Provider Demographics
NPI:1649302787
Name:SOLOMON, JEROME (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
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 1:1141 PEAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6484
Mailing Address - Country:US
Mailing Address - Phone:707-254-1774
Mailing Address - Fax:707-251-2995
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:707-257-7821
Practice Address - Fax:707-257-2006
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067070Medicaid
CAA89239Medicare UPIN
CAGR0067070Medicaid