Healthcare Provider Details

I. General information

NPI: 1962434282
Provider Name (Legal Business Name): EDWARD SOLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH & MARKET ST 4 PHI
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE ST 2 RHOADS PAVILLION
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD015397E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: