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General NPI Number Information
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NPI Number | 1013091115
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH DERMATOLOGY, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 7001 FOREST AVE STE. 400
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City | RICHMOND
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State | VA
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Zip | 23230-1726
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Country | US
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Telephone | 804-282-0831
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Fax | 804-288-7135
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Provider Business Mailing Address
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Address Line | 7001 FOREST AVE STE. 400
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City | RICHMOND
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State | VA
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Zip | 23230-1726
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Country | US
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Telephone | 804-282-0831
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Fax | 804-288-7135
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAZLE KONERDING
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Credential | MD
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Telephone | 804-282-0831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101233942
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 0101238054
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 0101053332
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 0101044250
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0017138217
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0017137835
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101026447
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License Number State | VA
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