Provider Demographics
NPI:1215925128
Name:KOMAN, JON D (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:KOMAN
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 1:116 WESTMINSTER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1027
Mailing Address - Country:US
Mailing Address - Phone:410-833-9300
Mailing Address - Fax:
Practice Address - Street 1:116 WESTMINSTER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1027
Practice Address - Country:US
Practice Address - Phone:410-833-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55676207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD293403500Medicaid
MD293403500Medicaid
MDA363Medicare ID - Type Unspecified