Healthcare Provider Details

I. General information

NPI: 1083610950
Provider Name (Legal Business Name): ANTHONY J COMEROTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 TELESTAR CT
FALLS CHURCH VA
22042-1205
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-5858
  • Fax: 703-849-0874
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101263955
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: