Healthcare Provider Details

I. General information

NPI: 1235566647
Provider Name (Legal Business Name): TODD M SOLOMON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 EAST CONCORD STREET, B-7800 BOSTON UNIVERSITY SCHOOL OF MEDICINE
BOSTON MA
02118
US

IV. Provider business mailing address

16 NATHAN PRATT DR 200
CONCORD MA
01742-4633
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-1197
  • Fax:
Mailing address:
  • Phone: 413-822-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: