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General NPI Number Information
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NPI Number | 1013715333
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH NEUROVASCULAR SPECIALISTS PC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1415 ROLKIN CT STE 203
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3643
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Country | US
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Telephone | 434-207-8320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8310
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City | ROANOKE
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State | VA
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Zip | 24014-0310
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Country | US
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Telephone | 540-345-3556
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Fax | 540-566-3889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN GAUGHEN
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Credential | MD
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Telephone | 540-345-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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