Provider Demographics
NPI:1063518462
Name:COMMONWEALTH HEART CENTER, INC.
Entity type:Organization
Organization Name:COMMONWEALTH HEART CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:ZEEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-288-8257
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-288-8257
Mailing Address - Fax:804-288-3917
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-288-8257
Practice Address - Fax:804-288-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI5817234Medicaid
VA497780OtherAETNA/USHEALTHCARE
VA204838OtherANTHEM BLUE CROSS
VAC06333Medicare PIN
VA497780OtherAETNA/USHEALTHCARE