Healthcare Provider Details

I. General information

NPI: 1609033208
Provider Name (Legal Business Name): BENJAMIN SOLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD CLAUDE MOORE BUILDING, 2ND FLOOR
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3300 GALLOWS RD CLAUDE MOORE BUILDING, 2ND FLOOR
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6118
  • Fax:
Mailing address:
  • Phone: 703-776-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0101254769
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD036525
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: