Provider Demographics
NPI:1326018433
Name:MCCOMB, DAVID R (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:MCCOMB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-0445
Mailing Address - Country:US
Mailing Address - Phone:609-953-5517
Mailing Address - Fax:609-953-1135
Practice Address - Street 1:109 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2038
Practice Address - Country:US
Practice Address - Phone:609-953-5517
Practice Address - Fax:609-953-1135
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB697722084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002232Medicaid
NJH86525Medicare UPIN
070605Medicare PIN