Provider Demographics
NPI:1821282229
Name:COMMONWEALTH NEUROSURGERY
Entity Type:Organization
Organization Name:COMMONWEALTH NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEBRAILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-729-4692
Mailing Address - Street 1:19465 DEERFIELD AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 307
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1705
Practice Address - Country:US
Practice Address - Phone:703-729-4692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052907207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty