Healthcare Provider Details

I. General information

NPI: 1013272764
Provider Name (Legal Business Name): KARISSA CARMELLA COMFORT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST DEPT OF
BOSTON MA
02114-2621
US

IV. Provider business mailing address

75 FRANCIS ST DEPARTMENT OF ORTHOPAEDIC SURGERY
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-8636
  • Fax: 617-726-7587
Mailing address:
  • Phone: 617-732-5362
  • Fax: 617-732-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055527
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: