Provider Demographics
NPI:1568910560
Name:COMSTOCK, ERICA TROIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:TROIA
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7193 FARNHAM RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:NY
Mailing Address - Zip Code:13112-8764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7193 FARNHAM RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:NY
Practice Address - Zip Code:13112-8764
Practice Address - Country:US
Practice Address - Phone:315-857-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
NY020275363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical