MEDICARE: JON D KOMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	D55676	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215925128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON D KOMAN MD

Provider Business Mailing Address
First Line	:	116 WESTMINSTER PIKE
Second Line	:	SUITE 100
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1027
Country	:	US
Telephone Number	:	410-833-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 WESTMINSTER PIKE
Second Line	:	SUITE 100
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1027
Country	:	US
Telephone Number	:	410-833-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	04/03/2014

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