Provider Demographics
NPI:1235233313
Name:COMIA, EILEEN C (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:C
Last Name:COMIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOLLEY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3062
Mailing Address - Country:US
Mailing Address - Phone:860-242-2200
Mailing Address - Fax:860-242-2212
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3062
Practice Address - Country:US
Practice Address - Phone:860-242-2200
Practice Address - Fax:860-242-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359050Medicaid
CT7777840121OtherCONNECTICARE
CT010035905CT04OtherBLUE CROSS BLUE SHIELD
CT001359050Medicaid
CT110009228Medicare ID - Type Unspecified