Provider Demographics
NPI:1063944841
Name:SOLOMON, KENISHA S
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:S
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 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:DEPT OF MEDICINE WASHINGTON DC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-8168
Mailing Address - Fax:877-303-1460
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:DEPT OF MEDICINE WASHINGTON DC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8168
Practice Address - Fax:877-303-1460
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD91890207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty