Healthcare Provider Details

I. General information

NPI: 1831164060
Provider Name (Legal Business Name): SARRA GWYN SOLOMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

IV. Provider business mailing address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-8639
  • Fax:
Mailing address:
  • Phone: 607-535-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number189534-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number189534-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: