Provider Demographics
NPI:1811008055
Name:COMISSIONG, SIDNEY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:JAMES
Last Name:COMISSIONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306813
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-6813
Mailing Address - Country:US
Mailing Address - Phone:340-777-8520
Mailing Address - Fax:340-779-7256
Practice Address - Street 1:SUITE 207
Practice Address - Street 2:VI MEDICAL FOUNDATION
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-777-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI923208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIBC2423868Medicare UPIN