Basic Information
| Provider Information | |||||||||
| NPI: | 1659372233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLLI | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 NORLAND AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176944 | ||||||||
| FaxNumber: | 7172176955 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 NORLAND AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176944 | ||||||||
| FaxNumber: | 7172176955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD422418 | PA | N | Other Service Providers | Specialist | 207RC0000X | MD422418 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P00278952 | 01 | MEDICARE RAILROAD | OTHER | 001974948 0001 | 05 | PA | MEDICAID |