=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528014578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONWEALTH INPATIENT PHYSICIANS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44045 RIVERSIDE PKWY INOVA LOUDOUN HOSPITAL
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-5101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-858-6044
-----------------------------------------------------
Fax | 610-617-6280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17668 COMMONWEALTH INPATIENT PHYSICIANS, LLC
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21297-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-668-6491
-----------------------------------------------------
Fax | 610-617-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDWARD V PUCCIO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-858-6044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------