Provider Demographics
NPI:1881700177
Name:SALOMON, ADRIENNE L (DO)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:L
Last Name:SALOMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:L
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14 KENNEDY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1435
Mailing Address - Country:US
Mailing Address - Phone:607-756-9941
Mailing Address - Fax:315-634-6789
Practice Address - Street 1:14 KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1435
Practice Address - Country:US
Practice Address - Phone:607-756-9941
Practice Address - Fax:315-634-6789
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02816053Medicaid
NYI71268Medicare UPIN