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General NPI Number Information
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NPI Number | 1700042231
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Entity Type | Individual
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Provider Name | MICHAEL TOBEH KOMETA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 804-765-5991
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Fax | 804-765-5244
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Provider Business Mailing Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 804-765-5991
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Fax | 804-765-5244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | KOME3968700
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 0101249428
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License Number State | VA
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