Provider Demographics
NPI:1376710715
Name:COMMONWEALTH PEDIATRICS PC
Entity Type:Organization
Organization Name:COMMONWEALTH PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-526-0346
Mailing Address - Street 1:430 CLAIRMONT COURT
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-526-0346
Mailing Address - Fax:804-526-7675
Practice Address - Street 1:430 CLAIRMONT COURT
Practice Address - Street 2:SUITE 211
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-526-0346
Practice Address - Fax:804-526-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty