Provider Demographics
NPI:1427028802
Name:ZERDEN, SOLOMON G (MD)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:G
Last Name:ZERDEN
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 1:7505 WATERS AVE
Mailing Address - Street 2:SUITE C8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3825
Mailing Address - Country:US
Mailing Address - Phone:912-352-2606
Mailing Address - Fax:912-352-0623
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:STE 102
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-355-2116
Practice Address - Fax:912-355-3653
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0247432085R0202X
SC159562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL908957800Medicaid
GA00256077AMedicaid
GA027351OtherBLUECROSS BLUESHIELD GA
SCR24743Medicaid
SC300025633Medicare ID - Type UnspecifiedRAILROAD
GA00256077AMedicaid
GA300044575Medicare ID - Type UnspecifiedRAILROAD
GA30CDBQGMedicare ID - Type Unspecified
SCR24743Medicaid