Provider Demographics
NPI:1184079121
Name:COMMONWEALTH WEIGHT LOSS, LLC
Entity type:Organization
Organization Name:COMMONWEALTH WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-418-1900
Mailing Address - Street 1:91 MONTVALE AVE
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 MONTVALE AVE
Practice Address - Street 2:SUITE 208B
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3623
Practice Address - Country:US
Practice Address - Phone:781-418-1900
Practice Address - Fax:781-418-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100267203Medicare PIN