Provider Demographics
NPI:1467438515
Name:COMMONWEALTH CANCER INSTITUTE
Entity Type:Organization
Organization Name:COMMONWEALTH CANCER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-257-7337
Mailing Address - Street 1:1109 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3835
Mailing Address - Country:US
Mailing Address - Phone:804-357-7337
Mailing Address - Fax:804-359-6898
Practice Address - Street 1:1109 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3835
Practice Address - Country:US
Practice Address - Phone:804-357-7337
Practice Address - Fax:804-359-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA70218OtherSOUTHERN HEALTH
VA2810348OtherAETNA USHC
VAC05267Medicare PIN
VA2810348OtherAETNA USHC