Provider Demographics
NPI:1558559369
Name:COMMONWEALTH DME, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GNEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-438-2838
Mailing Address - Street 1:38 MONTVALE AVE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2446
Mailing Address - Country:US
Mailing Address - Phone:781-438-3301
Mailing Address - Fax:781-438-3302
Practice Address - Street 1:38 MONTVALE AVE
Practice Address - Street 2:SUITE 265
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:781-438-3301
Practice Address - Fax:781-438-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies