MEDICARE: DR. STEVEN M SOLOMON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	222667	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178885	OTHER	NY	MVP
2	000402793001	OTHER	NY	BLUE SHIELD OF NENY
3	10063801	OTHER	NY	CDPHP

General Provider Information

NPI Number	:	1225060551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M SOLOMON MD

Provider Business Mailing Address
First Line	:	535 BAY RD
Second Line	:	#1
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3018
Country	:	US
Telephone Number	:	518-793-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 BAY RD
Second Line	:	#1
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3018
Country	:	US
Telephone Number	:	518-793-0331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/31/2008

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