Provider Demographics
NPI:1073121489
Name:COMMONWEALTH MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:COMMONWEALTH MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:JALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-957-4474
Mailing Address - Street 1:505 NASHUA RD STE 8
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1929
Mailing Address - Country:US
Mailing Address - Phone:978-957-4474
Mailing Address - Fax:
Practice Address - Street 1:505 NASHUA RD STE 8
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1929
Practice Address - Country:US
Practice Address - Phone:978-957-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty