Healthcare Provider Details

I. General information

NPI: 1528002763
Provider Name (Legal Business Name): KARL J KOMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
WATERTOWN NY
13601
US

IV. Provider business mailing address

158 WOODRUFF ST
WATERTOWN NY
13601-4317
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-4545
  • Fax: 315-785-4331
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number1964471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: