Provider Demographics
NPI:1154524502
Name:WILSON S. COMER, JR., M.D., P.A.
Entity type:Organization
Organization Name:WILSON S. COMER, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:COMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:919-833-5867
Mailing Address - Street 1:867 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1255
Mailing Address - Country:US
Mailing Address - Phone:919-833-5867
Mailing Address - Fax:919-833-5859
Practice Address - Street 1:867 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1255
Practice Address - Country:US
Practice Address - Phone:919-833-5867
Practice Address - Fax:919-833-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344609Medicare ID - Type Unspecified