Provider Demographics
NPI:1487670675
Name:COMEYNE, ANITA DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:DIANE
Last Name:COMEYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:DIANE
Other - Last Name:WARFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3636 HIGH ST
Mailing Address - Street 2:SUITE 8600
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3236
Mailing Address - Country:US
Mailing Address - Phone:757-398-2222
Mailing Address - Fax:757-398-2030
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-398-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23117Medicare UPIN
970000443Medicare PIN