Active NPI
Martin J Kommor, M.D.
- Psychiatry Physician
- Charleston, WV
National Provider Identifier
1477650778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 10616
- Practice address
- 3200 Maccorkle Ave SE
5TH Floor Bahavioral Medicine
Charleston, WV 25304-1227 - Phone
- (304) 347-1300
- Fax
- (304) 347-1397
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 10616 | WV | Primary |
Addresses
Primary practice location
3200 Maccorkle Ave SE
5TH Floor Bahavioral Medicine
Charleston, WV 25304-1227
Mailing address
3200 Maccorkle Ave SE
5TH Floor Bahavioral Medicine
Charleston, WV 25304-1227
Phone (304) 347-1300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0116226000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380758400000",
"number": "1477650778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"address_2": "5TH FLOOR BAHAVIORAL MEDICINE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-347-1300",
"fax_number": "304-347-1397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"address_2": "5TH FLOOR BAHAVIORAL MEDICINE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-347-1300",
"fax_number": "304-347-1397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMMOR",
"first_name": "MARTIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2013-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WV",
"license": "10616",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0116226000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.