Provider Demographics
NPI:1952374746
Name:KOMASZ, JASON M (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:KOMASZ
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 1:595 W STATE ST
Mailing Address - Street 2:505
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2554
Mailing Address - Country:US
Mailing Address - Phone:215-933-0259
Mailing Address - Fax:215-933-3672
Practice Address - Street 1:260 NEW YORK DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2504
Practice Address - Country:US
Practice Address - Phone:215-643-7331
Practice Address - Fax:215-654-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071900L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001849752Medicaid
PA001849752Medicaid
050919Medicare ID - Type Unspecified