Provider Demographics
NPI:1750340709
Name:COMMONWEALTH INTERNAL MEDICINE & GERIATRICS PC
Entity type:Organization
Organization Name:COMMONWEALTH INTERNAL MEDICINE & GERIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HENGLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-883-0052
Mailing Address - Street 1:330 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6221
Mailing Address - Country:US
Mailing Address - Phone:804-545-6860
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:16618 MOUNTAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2649
Practice Address - Country:US
Practice Address - Phone:804-883-0052
Practice Address - Fax:804-883-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356679138OtherPHYSICIAN NPI
VAC08690Medicare PIN