Provider Demographics
NPI:1205880614
Name:SOLA-VISNER, MARTHA C (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:C
Last Name:SOLA-VISNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:C
Other - Last Name:SOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:79 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4045
Mailing Address - Country:US
Mailing Address - Phone:352-219-2707
Mailing Address - Fax:617-730-0260
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:ENDERS RESEARCH BUILDING, RM. 961
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-919-4845
Practice Address - Fax:617-730-0260
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2332822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014982660001Medicaid
PAH20835Medicare UPIN
PA1014982660001Medicaid