Healthcare Provider Details

I. General information

NPI: 1013082544
Provider Name (Legal Business Name): COMMONWEALTH PRIMARY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 RAYMOND ST SUITE 100
READING PA
19605-3149
US

IV. Provider business mailing address

2 MERIDIAN BLVD SECOND FLOOR
WYOMISSING PA
19610-3202
US

V. Phone/Fax

Practice location:
  • Phone: 610-921-1111
  • Fax: 610-921-2419
Mailing address:
  • Phone: 610-372-4957
  • Fax: 610-372-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERT HIPPERT
Title or Position: PRESIDENT OF CORPORATION
Credential: D.O.
Phone: 610-944-0464