Provider Demographics
NPI:1508833633
Name:COMMONWEALTH OB-GYN, P.C.
Entity Type:Organization
Organization Name:COMMONWEALTH OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:804-732-1286
Mailing Address - Street 1:50 MEDICAL PARK BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9274
Mailing Address - Country:US
Mailing Address - Phone:804-732-1286
Mailing Address - Fax:804-862-1158
Practice Address - Street 1:50 MEDICAL PARK BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:804-732-1286
Practice Address - Fax:804-862-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty