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General NPI Number Information
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NPI Number | 1609073485
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CLINIC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/03/2007
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Provider Practice Location Address
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Address Line | 10930 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3316
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Country | US
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Telephone | 804-674-7499
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Fax | 804-674-7448
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Provider Business Mailing Address
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Address Line | 10930 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3316
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Country | US
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Telephone | 804-674-7499
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Fax | 804-674-7448
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JUDITH LYNN PAWLAK
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Credential | PA-C
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Telephone | 804-674-7499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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