Provider Demographics
NPI:1548275308
Name:COMMONWEALTH ANESTHESIA ASSOCIATES, P.C.
Entity type:Organization
Organization Name:COMMONWEALTH ANESTHESIA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-594-2622
Mailing Address - Street 1:PO BOX 35808
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0808
Mailing Address - Country:US
Mailing Address - Phone:804-594-2622
Mailing Address - Fax:804-594-0915
Practice Address - Street 1:10800 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 265
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4724
Practice Address - Country:US
Practice Address - Phone:804-594-2622
Practice Address - Fax:804-594-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACC5016OtherRAILROAD MEDICARE
VACM7959OtherRAILROAD MEDICARE
VACH9191OtherRAILROAD MEDICARE
VACM7959OtherRAILROAD MEDICARE
VAC06988Medicare PIN