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Organization
COMMONWEALTH FAMILY PRACTICE LTD
Active
Organization
COMMONWEALTH FAMILY PRACTICE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIANNE LAND SIEGRIST DO (VICE PRESIDENT CEO)
(804) 748-6229
Entity
Organization
Contact information
Practice address
10201 KRAUSE RD, CHESTERFIELD, VA 23832-6575
(804) 748-6229
(804) 748-5909
Mailing address
10201 KRAUSE RD, CHESTERFIELD, VA 23832-6575
(804) 748-6229
(804) 748-5909
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
0102037160
VA
208D00000X
General Practice Physician
Primary
0102037170
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
287512
BLUE CROSS-BLUE SHIELD
—
01
—
318871
BLUE CROSS/BLUE SHIELD
—
01
—
H9571
RAILROAD MEDICARE
—
Enumeration date
07/19/2005
Last updated
04/20/2008
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