Provider Demographics
NPI:1891758330
Name:COMSTOCK, MICHAEL CHESTER (MC PA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHESTER
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:MC PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3410 EXECUTIVE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7450
Mailing Address - Country:US
Mailing Address - Phone:919-872-5296
Mailing Address - Fax:919-850-9718
Practice Address - Street 1:3410 EXECUTIVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7450
Practice Address - Country:US
Practice Address - Phone:919-872-5296
Practice Address - Fax:919-850-9718
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC38514207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0562450001Medicare NSC
NC2189431Medicare PIN