Provider Demographics
NPI:1194090035
Name:KOMIVES, EUGENIE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENIE
Middle Name:MARIE
Last Name:KOMIVES
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 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:267 S CHURTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2506
Practice Address - Country:US
Practice Address - Phone:919-732-8131
Practice Address - Fax:919-732-6802
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949949Medicaid
NCNC6813AMedicare PIN