Provider Demographics
NPI:1306945092
Name:GEDDIS-COMRIE, BRENDA J (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:GEDDIS-COMRIE
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 1:10 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1590
Mailing Address - Country:US
Mailing Address - Phone:508-248-3015
Mailing Address - Fax:508-248-4734
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1590
Practice Address - Country:US
Practice Address - Phone:508-248-3015
Practice Address - Fax:508-248-4734
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2144115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2144115Medicaid
MA000301903Medicare PIN
MA2144115Medicaid