Provider Demographics
NPI:1508101189
Name:GILBERT K. COMISSIONG, M.D. LLC
Entity Type:Organization
Organization Name:GILBERT K. COMISSIONG, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COMISSIONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:340-777-8599
Mailing Address - Street 1:PO BOX 9401
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-2401
Mailing Address - Country:US
Mailing Address - Phone:340-777-8599
Mailing Address - Fax:340-777-9927
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:SUITE 302
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-777-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1230208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI21370Medicare UPIN