Healthcare Provider Details

I. General information

NPI: 1528014578
Provider Name (Legal Business Name): COMMONWEALTH INPATIENT PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY INOVA LOUDOUN HOSPITAL
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

PO BOX 17668 COMMONWEALTH INPATIENT PHYSICIANS, LLC
BALTIMORE MD
21297-1668
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-6044
  • Fax: 610-617-6280
Mailing address:
  • Phone: 610-668-6491
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD V PUCCIO
Title or Position: PRESIDENT
Credential: MD
Phone: 703-858-6044