Provider Demographics
NPI:1508847286
Name:COMER-CONCORDIA, STEPHANIE SUSAN (CRNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:COMER-CONCORDIA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUSAN
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4475
Mailing Address - Country:US
Mailing Address - Phone:301-694-7788
Mailing Address - Fax:301-694-3184
Practice Address - Street 1:140 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4475
Practice Address - Country:US
Practice Address - Phone:301-694-3184
Practice Address - Fax:301-694-3184
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR125748363L00000X
PASP009117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q44502Medicare UPIN