Provider Demographics
NPI:1679572770
Name:SOLISH, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:SOLISH
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 1:2314 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4432
Mailing Address - Country:US
Mailing Address - Phone:215-634-2900
Mailing Address - Fax:215-634-5687
Practice Address - Street 1:2314 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4432
Practice Address - Country:US
Practice Address - Phone:215-634-2900
Practice Address - Fax:215-634-5687
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016369E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006047190004Medicaid
161487E08Medicare ID - Type Unspecified
PA0006047190004Medicaid