Provider Demographics
NPI:1841886397
Name:ID SOL PLLC
Entity type:Organization
Organization Name:ID SOL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANUPAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-234-7566
Mailing Address - Street 1:6811 KOALA DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-6604
Mailing Address - Country:US
Mailing Address - Phone:954-234-7566
Mailing Address - Fax:
Practice Address - Street 1:2401 S SIDE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3311
Practice Address - Country:US
Practice Address - Phone:336-604-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty