Provider Demographics
NPI:1881882082
Name:DAVID R. MCCOMB, DO, LLC
Entity type:Organization
Organization Name:DAVID R. MCCOMB, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-953-5517
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-0445
Mailing Address - Country:US
Mailing Address - Phone:609-953-5517
Mailing Address - Fax:609-953-1135
Practice Address - Street 1:239 TAUNTON BLVD
Practice Address - Street 2:A-2
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3471
Practice Address - Country:US
Practice Address - Phone:609-953-5517
Practice Address - Fax:609-953-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB697722084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002232Medicaid
089404Medicare PIN