Healthcare Provider Details

I. General information

NPI: 1538565635
Provider Name (Legal Business Name): COMMONWEALTH SLEEP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E PARHAM RD SUITE A
RICHMOND VA
23228-2760
US

IV. Provider business mailing address

PO BOX 6626
GLEN ALLEN VA
23058-6626
US

V. Phone/Fax

Practice location:
  • Phone: 804-977-2728
  • Fax: 804-977-2728
Mailing address:
  • Phone: 804-977-2728
  • Fax: 804-977-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101236604
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101236604
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0101236604
License Number StateVA

VIII. Authorized Official

Name: DR. ABDUL AMIR
Title or Position: OWNER
Credential: MD
Phone: 804-977-2728