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Organization
COMMONWEALTH CRITICAL CARE LLC
Active
Organization
COMMONWEALTH CRITICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PUCCIO MD (PRESIDENT)
(703) 858-6044
Entity
Organization
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6040
Mailing address
PO BOX 34834, ALEXANDRIA, VA 22334-0834
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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