Provider Demographics
NPI:1801177456
Name:SOLON, PETER CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHARLES
Last Name:SOLON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BASELINE RD
Mailing Address - Street 2:E104-412
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2699
Mailing Address - Country:US
Mailing Address - Phone:720-434-3177
Mailing Address - Fax:
Practice Address - Street 1:613 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5031
Practice Address - Country:US
Practice Address - Phone:720-434-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA1832Medicare PIN