Healthcare Provider Details

I. General information

NPI: 1407881907
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 WEST MARSHALL STREET
RICHMOND VA
23220
US

IV. Provider business mailing address

8002 DISCOVERY DR STE 410
RICHMOND VA
23229
US

V. Phone/Fax

Practice location:
  • Phone: 804-257-7337
  • Fax: 804-359-6898
Mailing address:
  • Phone: 804-288-0399
  • Fax: 804-288-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA H PATTON
Title or Position: CBO OFFICE MANAGER
Credential:
Phone: 804-288-0399