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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