Provider Demographics
NPI:1578290987
Name:SOLOMON, STEPHANIE GAYLE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GAYLE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 QUARRY LAKE DR STE 180
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3743
Mailing Address - Country:US
Mailing Address - Phone:410-601-2020
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR STE 180
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3743
Practice Address - Country:US
Practice Address - Phone:410-601-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist