Provider Demographics
NPI:1962408583
Name:SOLOMON, MARTIN DAVID (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:DAVID
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:STE 470
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3584
Mailing Address - Country:US
Mailing Address - Phone:817-481-8100
Mailing Address - Fax:817-421-6112
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:STE 470
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3584
Practice Address - Country:US
Practice Address - Phone:817-481-8100
Practice Address - Fax:817-421-6112
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH88452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123011205Medicaid
TX130006653OtherRR MEDICARE
TX8BF080OtherBCBS
TX8BF080OtherBCBS
TX123011205Medicaid