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NPI Code Detail

MEDICARE: COMMONWEALTH SURGICAL PROFESSIONALS LLC

MEDICARE: COMMONWEALTH SURGICAL PROFESSIONALS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1518655943
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMONWEALTH SURGICAL PROFESSIONALS LLC
Provider Business Mailing Address
First Line : 2300 WILSON BLVD STE 700
Second Line :
City : ARLINGTON
State : VA
Zip : 22201-5435
Country : US
Telephone Number : 757-439-0033
Fax Number :
Provider Business Practice Location Address
First Line : 2300 WILSON BLVD STE 700
Second Line :
City : ARLINGTON
State : VA
Zip : 22201-5435
Country : US
Telephone Number : 757-439-0033
Fax Number :
Authorized Official
Title or Position : FOUNDER/LICENSED SURGICAL ASSIST
Name : MR. ROBERT REID NOTTINGHAM JR.
Credential : LSA
Telephone Number : 757-439-0033
Provider Enumeration Date : 04/25/2023
Last Update Date : 04/27/2023

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Directions to “COMMONWEALTH SURGICAL PROFESSIONALS LLC ” Practice Location

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