Provider Demographics
NPI:1144385022
Name:COMMONWEALTH NEUROLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:COMMONWEALTH NEUROLOGICAL SPECIALISTS
Other - Org Name:IBRAHIM M HEGAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEGAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-353-0023
Mailing Address - Street 1:110 N ROBINSON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4459
Mailing Address - Country:US
Mailing Address - Phone:804-353-0023
Mailing Address - Fax:804-353-0773
Practice Address - Street 1:110 N ROBINSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4459
Practice Address - Country:US
Practice Address - Phone:804-353-0023
Practice Address - Fax:804-353-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012403072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty