Organization
COMMONWEALTH DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAZLE KONERDING MD (PRESIDENT)
(804) 282-0831
Entity
Organization
Contact information
Practice address
7001 FOREST AVE, STE. 400, RICHMOND, VA 23230-1726
(804) 282-0831
(804) 288-7135
Mailing address
7001 FOREST AVE, STE. 400, RICHMOND, VA 23230-1726
(804) 282-0831
(804) 288-7135
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101026447
VA
207N00000X
Dermatology Physician
0101233942
VA
207ND0101X
MOHS-Micrographic Surgery Physician
0101238054
VA
207NP0225X
Pediatric Dermatology Physician
0101044250
VA
207NP0225X
Pediatric Dermatology Physician
0101053332
VA
363LA2100X
Acute Care Nurse Practitioner
0017137835
VA
363LF0000X
Family Nurse Practitioner
0017138217
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057917
ANTHEM GROUP NO.
VA
01
—
3118456
AETNA GROUP NO.
VA
01
—
CB6342
RAILROAD MEDICARE
VA
Enumeration date
10/25/2006
Last updated
09/03/2014
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