Organization
COMMONWEALTH GENERAL & VASCULAR SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R POLIQUIN M.D. (PHYSICIAN)
(804) 330-5436
Entity
Organization
Contact information
Practice address
1401 JOHNSTON WILLIS DR, SUITE 5100, RICHMOND, VA 23235-4730
(804) 330-5436
(804) 560-0584
Mailing address
1401 JOHNSTON WILLIS DR, SUITE 5100, RICHMOND, VA 23235-4730
(804) 330-5436
(804) 560-0584
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101033088
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071139
ANTHEM
—
01
—
1013678
AETNA HMO
—
01
—
4543869
AETNA PPO/MC
—
Enumeration date
05/08/2006
Last updated
08/17/2018
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