1629261383 NPI number — MATTHIAS SOLOMON MD

Table of content: MATTHIAS SOLOMON MD (NPI 1629261383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629261383 NPI number — MATTHIAS SOLOMON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLOMON
Provider First Name:
MATTHIAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629261383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2161 MEADOW VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75078-9447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-851-0195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12655 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 650
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-234-0277
Provider Business Practice Location Address Fax Number:
972-474-9045
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  50155 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 28975 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: P3587 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1629261383 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629261383 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00632081 . This is a "MEDICARE, RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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