Healthcare Provider Details

I. General information

NPI: 1346235041
Provider Name (Legal Business Name): COMMONWEALTH PRIMARY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N RICHMOND ST
FLEETWOOD PA
19522-1031
US

IV. Provider business mailing address

2 MERIDIAN BLVD
WYOMISSING PA
19610-3202
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-0464
  • Fax:
Mailing address:
  • Phone: 610-372-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HIPPERT
Title or Position: HEAD PHYSICIAN
Credential: DO
Phone: 610-944-0464