Provider Demographics
NPI:1861529158
Name:SOLOMON, JOHN J (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 GREAT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6810
Mailing Address - Country:US
Mailing Address - Phone:401-768-3700
Mailing Address - Fax:
Practice Address - Street 1:594 GREAT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6810
Practice Address - Country:US
Practice Address - Phone:401-768-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003079Medicaid
F01189Medicare UPIN
RI9003079Medicaid