Healthcare Provider Details

I. General information

NPI: 1962889907
Provider Name (Legal Business Name): SHANE SOLGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET CONKLIN BUILDING, ROOM 130
HARTFORD CT
06102
US

IV. Provider business mailing address

80 SEYMOUR ST CONKLIN BUILDING, ROOM 130
HARTFORD CT
06106-3300
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-1448
  • Fax:
Mailing address:
  • Phone: 860-545-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number329335
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number80483
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number80483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: