Provider Demographics
NPI:1508864505
Name:KOMIN, MARIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:J
Last Name:KOMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7300 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-5705
Mailing Address - Country:US
Mailing Address - Phone:716-298-5862
Mailing Address - Fax:716-285-3622
Practice Address - Street 1:7300 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-5705
Practice Address - Country:US
Practice Address - Phone:716-298-5862
Practice Address - Fax:716-285-3622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY170669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01023752Medicaid
NY01023752Medicaid
NYDD5604Medicare ID - Type Unspecified