Organization
COMMONWEALTH PRIMARY CARE
Active
Organization
COMMONWEALTH PRIMARY CARE
Active
Other names
CPC Hospitalist Division
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY SHEPHERD (HOSPITALIST ADMINISTRATOR)
(804) 521-5315
Entity
Organization
Contact information
Practice address
4050 INNSLAKE DR, STE 308, GLEN ALLEN, VA 23060
(804) 521-5310
(804) 521-5312
Mailing address
4050 INNSLAKE DR, STE 308, GLEN ALLEN, VA 23060-3327
(804) 521-5315
(804) 521-5312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139440
ANTHEM BCBS
VA
01
—
139444
ANTHEM BCBS
VA
01
—
CC6597
MEDICARE RR
VA
Enumeration date
08/03/2006
Last updated
11/08/2007
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