Healthcare Provider Details

I. General information

NPI: 1306945092
Provider Name (Legal Business Name): BRENDA J GEDDIS-COMRIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
CHARLTON MA
01507-1590
US

IV. Provider business mailing address

10 N MAIN ST
CHARLTON MA
01507-1590
US

V. Phone/Fax

Practice location:
  • Phone: 508-248-3015
  • Fax: 508-248-4734
Mailing address:
  • Phone: 508-248-3015
  • Fax: 508-248-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2144115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: