MEDICARE: DR. R SOLOMON M.D.

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	208610	NY

General Provider Information

NPI Number	:	1366516262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. R SOLOMON M.D.

Provider Business Mailing Address
First Line	:	4711 FOREST DR STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3125
Country	:	US
Telephone Number	:	646-450-8990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 FOREST DR STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3125
Country	:	US
Telephone Number	:	646-450-8990
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/11/2016

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