Provider Demographics
NPI:1003188483
Name:COMMONWEALTH GASTROENTEROLOGY, PLC
Entity Type:Organization
Organization Name:COMMONWEALTH GASTROENTEROLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-262-0200
Mailing Address - Street 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:#201
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:#1000
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-262-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty