Healthcare Provider Details

I. General information

NPI: 1417029802
Provider Name (Legal Business Name): PAUL R. SOLOMON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WELLS AVENUE SUITE 304
NEWTON MA
02459
US

IV. Provider business mailing address

180 WELLS AVENUE SUITE 304
NEWTON MA
02459
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1409
  • Fax: 802-442-5199
Mailing address:
  • Phone: 617-699-6927
  • Fax: 617-383-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number743
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: