Basic Information
| Provider Information | |||||||||
| NPI: | 1083610950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMEROTA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 2921 TELESTAR CT | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032805858 | ||||||||
| FaxNumber: | 7038490874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 0101263955 | VA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 344428256 | 01 | OH | FRONTPATH | OTHER | 4202913 | 01 | OH | AETNA | OTHER | 4433600 | 05 | MI | MEDICAID | PH00102397 | 01 | OH | NATIONWIDE | OTHER | 000000250121 | 01 | OH | ANTHEM | OTHER | 142215 | 01 | OH | CARE CHOICE | OTHER | 344428256036 | 01 | OH | HEALTHNET | OTHER | 7218526 | 01 | OH | CIGNA | OTHER | 344428256 | 01 | OH | EMERALD | OTHER | 344428256011 | 01 | OH | BWC | OTHER | 4433576 | 05 | MI | MEDICAID | 000000250121 | 01 | OH | ANHTEM MEDICAID | OTHER | 04225 | 01 | OH | PARMOUNT | OTHER | 0453254 | 05 | OH | MEDICAID | 344428256 | 01 | CA | BEECH STREET | OTHER |