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General NPI Number Information
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NPI Number | 1215936547
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH FAMILY PRACTICE LTD
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 10201 KRAUSE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6575
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Country | US
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Telephone | 804-748-6229
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Fax | 804-748-5909
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Provider Business Mailing Address
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Address Line | 10201 KRAUSE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6575
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Country | US
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Telephone | 804-748-6229
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Fax | 804-748-5909
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Authorized Official
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Title or Position | VICE PRESIDENT CEO
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Name | DR. MARIANNE LAND SIEGRIST
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Credential | DO
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Telephone | 804-748-6229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102037160
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102037170
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License Number State | VA
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