MEDICARE: MR. SCOTT SOLOMON

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant	9114080	FL
3	363A00000X	Physician Assistant		NY

General Provider Information

NPI Number	:	1619377363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT SOLOMON

Provider Business Mailing Address
First Line	:	10336 CARROLL COVE PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1786
Country	:	US
Telephone Number	:	718-270-2045
Fax Number	:

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

Provider Enumeration Date	:	08/31/2014
Last Update Date	:	08/17/2024

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Directions to “ MR. SCOTT SOLOMON ” Practice Location

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