Provider Demographics
NPI:1053679886
Name:COMARATTA, MARC FIDELIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:FIDELIS
Last Name:COMARATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W DICKERSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6851
Mailing Address - Country:US
Mailing Address - Phone:406-284-2370
Mailing Address - Fax:406-284-2372
Practice Address - Street 1:1940 W DICKERSON ST STE 103
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:406-284-2370
Practice Address - Fax:406-284-2372
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML.60383942207W00000X
AZ51780207WX0107X
MT60990207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117905Medicaid