Provider Demographics
NPI:1982692752
Name:SOLOMON, JUDITH L (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1840 W MARYLAND AVE
Mailing Address - Street 2:STE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1705
Mailing Address - Country:US
Mailing Address - Phone:602-246-3300
Mailing Address - Fax:602-246-3303
Practice Address - Street 1:1840 W MARYLAND AVE
Practice Address - Street 2:STE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1705
Practice Address - Country:US
Practice Address - Phone:602-246-3300
Practice Address - Fax:602-246-3303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468571Medicaid
AZZ78362Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
G73211Medicare UPIN