Healthcare Provider Details

I. General information

NPI: 1588607808
Provider Name (Legal Business Name): ANDREW KEITH SOLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE STE 211
BOTHELL WA
98021-4418
US

IV. Provider business mailing address

1909 214TH ST SE STE 211
BOTHELL WA
98021-4418
US

V. Phone/Fax

Practice location:
  • Phone: 425-248-2626
  • Fax: 425-248-2627
Mailing address:
  • Phone: 425-248-2626
  • Fax: 425-248-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00028680
License Number StateWA

VII. Legacy identifiers

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

# 1
Identifier1066679
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: