Provider Demographics
NPI:1467485011
Name:KOMM, EDWIN (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:KOMM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2129
Mailing Address - Country:US
Mailing Address - Phone:412-732-9801
Mailing Address - Fax:
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3540
Practice Address - Country:US
Practice Address - Phone:412-373-1626
Practice Address - Fax:412-373-2406
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA055657EHWMedicare ID - Type Unspecified