Provider Demographics
NPI:1497202444
Name:KOMAN ORTHOPEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:KOMAN ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-833-9300
Mailing Address - Street 1:116 WESTMINSTER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1027
Mailing Address - Country:US
Mailing Address - Phone:410-833-9300
Mailing Address - Fax:855-485-4166
Practice Address - Street 1:116 WESTMINSTER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1027
Practice Address - Country:US
Practice Address - Phone:410-833-9300
Practice Address - Fax:855-485-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD468303000Medicaid
MD7147350001Medicare UPIN