Provider Demographics
NPI:1306149851
Name:DE JESUS, SOL (MD)
Entity type:Individual
Prefix:DR
First Name:SOL
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HOPE DR
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, M.C. EC037
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2036
Mailing Address - Country:US
Mailing Address - Phone:717-531-0003
Mailing Address - Fax:717-531-0384
Practice Address - Street 1:30 HOPE DR
Practice Address - Street 2:SUITE #1200
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12630-I2084N0400X
PAMD45993942084N0400X
FLME1205982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013045800Medicaid
FLHY143ZMedicare PIN