Healthcare Provider Details

I. General information

NPI: 1114679974
Provider Name (Legal Business Name): ROBEL SOLOMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 WAPLES MILL RD STE 100
FAIRFAX VA
22030-7475
US

IV. Provider business mailing address

6276 EDSALL RD APT 213
ALEXANDRIA VA
22312-2641
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax:
Mailing address:
  • Phone: 571-230-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: