Provider Demographics
NPI:1255356440
Name:COMSTOCK, KEVYN L (DO)
Entity type:Individual
Prefix:DR
First Name:KEVYN
Middle Name:L
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8560
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:700 MOUNT HOPE AVE STE 210
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5655
Practice Address - Country:US
Practice Address - Phone:207-907-3030
Practice Address - Fax:207-907-3031
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEDO1817207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI38954Medicare UPIN