MEDICARE: ANITA M SOLOMON MS, CCC-A, F-AAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	762	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	SO 039764	OTHER	MA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	26550	OTHER	FALLON
2	5104033	OTHER	MASS HEALTH
3	AD0187	OTHER	AETNA
5	AD0187	OTHER	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780758805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA M SOLOMON MS, CCC-A, F-AAA

Provider Business Mailing Address
First Line	:	295 LINCOLN ST
Second Line	:	STE 105
City	:	WORCESTER
State	:	MA
Zip	:	01605
Country	:	US
Telephone Number	:	508-755-1391
Fax Number	:	508-363-4019

Provider Business Practice Location Address
First Line	:	295 LINCOLN ST
Second Line	:	SUITE 105
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-755-1391
Fax Number	:	508-363-4019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	12/03/2007

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Directions to “ ANITA M SOLOMON MS, CCC-A, F-AAA” Practice Location

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