Provider Demographics
NPI:1831371764
Name:COMMONWEALTH PSYCHIATRIC ASSOC PC
Entity type:Organization
Organization Name:COMMONWEALTH PSYCHIATRIC ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:STRANGE
Authorized Official - Last Name:DEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-472-7988
Mailing Address - Street 1:1312 KILDEER CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4921
Mailing Address - Country:US
Mailing Address - Phone:757-472-7988
Mailing Address - Fax:757-961-3573
Practice Address - Street 1:317 OFFICE SQUARE LN STE B102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3650
Practice Address - Country:US
Practice Address - Phone:757-472-7988
Practice Address - Fax:757-961-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE73045Medicare UPIN
VAB05687Medicare UPIN