Provider Demographics
NPI:1699741850
Name:SOLANO, SIMON (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:SOLANO
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 1:192 N RUNWAY RD
Mailing Address - Street 2:
Mailing Address - City:PERKINSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05151-9651
Mailing Address - Country:US
Mailing Address - Phone:802-263-5352
Mailing Address - Fax:
Practice Address - Street 1:29 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3060
Practice Address - Country:US
Practice Address - Phone:802-886-3556
Practice Address - Fax:802-886-2535
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008598207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0574Medicaid
RE3799OtherMEDICARE PROVIDER NUMBER
VTOVN0574Medicaid