Provider Demographics
NPI:1194004093
Name:COMMONWEALTH VASCULAR INSTITUTE
Entity Type:Organization
Organization Name:COMMONWEALTH VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPC-A, CPC-H-A
Authorized Official - Phone:757-539-7824
Mailing Address - Street 1:150 BURNETTS WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8168
Mailing Address - Country:US
Mailing Address - Phone:757-539-7824
Mailing Address - Fax:757-538-9474
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-539-7824
Practice Address - Fax:757-538-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053967208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty