Healthcare Provider Details

I. General information

NPI: 1235233313
Provider Name (Legal Business Name): EILEEN C COMIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JOLLEY DR SUITE 102
BLOOMFIELD CT
06002-3062
US

IV. Provider business mailing address

35 JOLLEY DR SUITE 102
BLOOMFIELD CT
06002-3062
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-2200
  • Fax: 860-242-2212
Mailing address:
  • Phone: 860-242-2200
  • Fax: 860-242-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number035905
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001359050
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier7777840121
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCONNECTICARE
# 3
Identifier010035905CT04
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: