Provider Demographics
NPI:1477507895
Name:COMEAU HEALTH CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:COMEAU HEALTH CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-774-5600
Mailing Address - Street 1:194 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1242
Mailing Address - Country:US
Mailing Address - Phone:978-774-5600
Mailing Address - Fax:978-774-5601
Practice Address - Street 1:194 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1242
Practice Address - Country:US
Practice Address - Phone:978-774-5600
Practice Address - Fax:978-774-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1602535Medicaid
MAY35015Medicare ID - Type Unspecified
MAT57949Medicare UPIN