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General NPI Number Information
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NPI Number | 1194004093
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH VASCULAR INSTITUTE
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 150 BURNETTS WAY SUITE 200
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City | SUFFOLK
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State | VA
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Zip | 23434-8168
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Country | US
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Telephone | 757-539-7824
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Fax | 757-538-9474
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Provider Business Mailing Address
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Address Line | 150 BURNETTS WAY SUITE 200
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City | SUFFOLK
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State | VA
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Zip | 23434-8168
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Country | US
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Telephone | 757-539-7824
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Fax | 757-538-9474
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MS. BONNIE WRIGHT
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Credential | CPC-A, CPC-H-A
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Telephone | 757-539-7824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101053967
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 0101053967
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101053967
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License Number State | VA
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