1457367476 NPI number — MRS. BARBARA S SOLOMON MA

Table of content: MRS. BARBARA S SOLOMON MA (NPI 1457367476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457367476 NPI number — MRS. BARBARA S SOLOMON MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLOMON
Provider First Name:
BARBARA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

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:
1457367476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 CLAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47906-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-494-3820
Provider Business Mailing Address Fax Number:
765-494-0771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1353 HEAVILON HALL
Provider Second Line Business Practice Location Address:
500 OVAL DRIVE
Provider Business Practice Location Address City Name:
WEST LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47907-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-494-3820
Provider Business Practice Location Address Fax Number:
765-494-0771
Provider Enumeration Date:
07/31/2006

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: 235Z00000X , with the licence number:  22001072A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000582177 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200903200 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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