Organization
COMMONWEALTH INTERNAL MEDICINE AND PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA KEENE MD (OWNER)
(859) 907-4299
Entity
Organization
Contact information
Practice address
1532 SLATE CREEK RD STE 106, BOX 173, GRUNDY, VA 24614-6975
(276) 935-1592
Mailing address
PO BOX 713, 1532 SLATE CREEK ROAD SUITE 106, GRUNDY, VA 24614-0713
(276) 935-1592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101246820
VA
208000000X
Pediatrics Physician
0101246820
VA
Other
Enumeration date
03/30/2010
Last updated
03/30/2010
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