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
—
01
—
318871
BLUE CROSS/BLUE SHIELD
—
01
—
H9571
RAILROAD MEDICARE
—
Enumeration date
07/19/2005
Last updated
04/20/2008
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