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Organization
COMMONWEALTH EAR, NOSE & THROAT SPECIALISTS PC
Active
Organization
COMMONWEALTH EAR, NOSE & THROAT SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK J GIBBONS M.D. (PRESIDENT)
(540) 345-3556
Entity
Organization
Contact information
Practice address
14051 ST FRANCIS BLVD, SUITE 2211, MIDLOTHIAN, VA 23114-3201
(540) 345-3556
(540) 342-2193
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
(540) 342-2193
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
010122975
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006501478
—
VA
01
—
269573
ANTHEM
VA
Enumeration date
08/31/2006
Last updated
07/14/2010
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