Healthcare Provider Details

I. General information

NPI: 1710996871
Provider Name (Legal Business Name): BYRNE LINCOLN SOLBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 PAOLI PIKE
MALVERN PA
19355-3311
US

IV. Provider business mailing address

414 PAOLI PIKE
MALVERN PA
19355-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-596-3943
  • Fax: 610-296-4915
Mailing address:
  • Phone: 484-596-3943
  • Fax: 610-296-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD025907E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier104240801
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: