Provider Demographics
NPI:1750703864
Name:KOMAN ORTHOPEDICS AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:KOMAN ORTHOPEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ORTHOPEDIC SURGEON
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 STE 100
Mailing Address - Street 2:
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:2014-01-08
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055676207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH812A363OtherMEDICARE PTAN