Provider Demographics
NPI:1285744516
Name:KCOMT, JUANITA REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:REGINA
Last Name:KCOMT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:#1
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:#1
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:215-657-2018
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-05-26
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Provider Licenses
StateLicense IDTaxonomies
PAMD432340207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10963034002Medicaid
PA113545FAGMedicare PIN
PA10963034002Medicaid