Provider Demographics
NPI:1306921499
Name:SOLARIN, KOLAWOLE O (MD)
Entity type:Individual
Prefix:DR
First Name:KOLAWOLE
Middle Name:O
Last Name:SOLARIN
Suffix:
Gender:M
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice Address - Street 2:111 S. 11TH STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:215-923-9519
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049764L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001698077Medicaid
NJ7563205Medicaid
MD1423037Medicaid
NY02071887Medicaid
PA001698077Medicaid
022769SAJMedicare PIN