Provider Demographics
NPI:1639578594
Name:COMER, MARY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLUM
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2445
Mailing Address - Country:US
Mailing Address - Phone:412-292-9011
Mailing Address - Fax:
Practice Address - Street 1:169 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8082
Practice Address - Country:US
Practice Address - Phone:724-627-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant