Provider Demographics
NPI:1902167224
Name:SOLOMON, SELAM D
Entity Type:Individual
Prefix:
First Name:SELAM
Middle Name:D
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 GEORGIA AVE
Mailing Address - Street 2:APT # 414B
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3603
Mailing Address - Country:US
Mailing Address - Phone:301-332-8017
Mailing Address - Fax:
Practice Address - Street 1:7600 GEORGIA AVE NW STE 323
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1616
Practice Address - Country:US
Practice Address - Phone:202-723-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN1044385163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide