Provider Demographics
NPI:1326542622
Name:COMOTTO, JAMES LEO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEO
Last Name:COMOTTO
Suffix:JR
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 1:701 W PRATT ST RM 474
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-6325
Mailing Address - Fax:
Practice Address - Street 1:701 W PRATT ST RM 474
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4769342084P0800X
MDD895122084P0800X
390200000X
DEC1-00246612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDR-0025136OtherCSR
PAMD476934OtherMEDICAL LICENSE
DEC1-0024661OtherMEDICAL LICENSE
MDD89512OtherMEDICAL LICENSE
PAMD476934OtherMEDICAL LICENSE