Provider Demographics
NPI:1801941513
Name:EILEEN C. COMIA, MD, LLC
Entity type:Organization
Organization Name:EILEEN C. COMIA, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:COMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-242-2200
Mailing Address - Street 1:35 JOLLEY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3062
Mailing Address - Country:US
Mailing Address - Phone:860-242-2200
Mailing Address - Fax:860-242-2212
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3062
Practice Address - Country:US
Practice Address - Phone:860-242-2200
Practice Address - Fax:860-242-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001184363L00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03656OtherMEDICARE PTAN
CT010035905CT06OtherANTHEM
CT001359050Medicaid
CTC03656OtherMEDICARE PTAN