1508847286 NPI number — STEPHANIE SUSAN COMER-CONCORDIA CRNP

Table of content: STEPHANIE SUSAN COMER-CONCORDIA CRNP (NPI 1508847286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508847286 NPI number — STEPHANIE SUSAN COMER-CONCORDIA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMER-CONCORDIA
Provider First Name:
STEPHANIE
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COMER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508847286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-694-7788
Provider Business Mailing Address Fax Number:
301-694-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-3184
Provider Business Practice Location Address Fax Number:
301-694-3184
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R125748 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: SP009117 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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