Healthcare Provider Details

I. General information

NPI: 1689609182
Provider Name (Legal Business Name): COMMONWEALTH PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 HUGUENOT RD SUITE A
MIDLOTHIAN VA
23113-2426
US

IV. Provider business mailing address

1800 GLENSIDE DR SUITE 105
RICHMOND VA
23226-3769
US

V. Phone/Fax

Practice location:
  • Phone: 804-378-7373
  • Fax: 804-378-7728
Mailing address:
  • Phone: 804-288-0399
  • Fax: 804-285-0088

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: ERIKA PARRISH
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 804-288-0399