Provider Demographics
NPI:1538192653
Name:KCOMT, MYRNA (MD)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:KCOMT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CATHARINE ST
Mailing Address - Street 2:P.O. BOX 550
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3100
Mailing Address - Country:US
Mailing Address - Phone:866-885-2318
Mailing Address - Fax:
Practice Address - Street 1:68 HARRIS-BUSHVILLE ROAD
Practice Address - Street 2:CATSKILL REGIONAL MEDICAL CENTER
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-3300
Practice Address - Fax:845-790-2675
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002216-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691481Medicaid
NY02691481Medicaid
I25924Medicare UPIN