Provider Demographics
NPI:1679976815
Name:KOMAN ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:KOMAN ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-833-9300
Mailing Address - Street 1:116 WESTMINSTER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1027
Mailing Address - Country:US
Mailing Address - Phone:410-833-9300
Mailing Address - Fax:
Practice Address - Street 1:116 WESTMINSTER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1027
Practice Address - Country:US
Practice Address - Phone:410-833-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2020-03-05
Deactivation Date:2018-02-08
Deactivation Code:
Reactivation Date:2020-03-05
Provider Licenses
StateLicense IDTaxonomies
MDD0055676261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy