Healthcare Provider Details

I. General information

NPI: 1952575425
Provider Name (Legal Business Name): MICHAEL C COMSTOCK MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 EXECUTIVE DR STE 103
RALEIGH NC
27609-7457
US

IV. Provider business mailing address

3410 EXECUTIVE DR STE 103
RALEIGH NC
27609-7457
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-5296
  • Fax: 919-850-9718
Mailing address:
  • Phone: 919-872-5296
  • Fax: 919-850-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36506
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL C COMSTOCK
Title or Position: OWNER
Credential: M.D.
Phone: 919-872-5296