MEDICARE: COMMONWEALTH PRIMARY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CC6597	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	303278	OTHER	VA	ANTHEM
2	304078	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1356532634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH PRIMARY CARE

Provider Business Mailing Address
First Line	:	8002 DISCOVERY DR
Second Line	:	SUITE 410
City	:	RICHMOND
State	:	VA
Zip	:	23229-8601
Country	:	US
Telephone Number	:	804-288-0399
Fax Number	:	804-285-0088

Provider Business Practice Location Address
First Line	:	9930 INDEPENDENCE PARK DR
Second Line	:	SUITE 101
City	:	RICHMOND
State	:	VA
Zip	:	23233-1476
Country	:	US
Telephone Number	:	804-726-2600
Fax Number	:

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	MS. CHERYL DANIEL
Credential	:
Telephone Number	:	804-288-0399

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	11/28/2007

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Directions to “COMMONWEALTH PRIMARY CARE ” Practice Location

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