Provider Demographics
NPI:1417973090
Name:COMMONWEALTH SURGERY SPECIALIST, P.C.
Entity Type:Organization
Organization Name:COMMONWEALTH SURGERY SPECIALIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-371-7372
Mailing Address - Street 1:306 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1400
Mailing Address - Country:US
Mailing Address - Phone:540-371-7372
Mailing Address - Fax:540-371-3002
Practice Address - Street 1:306 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1400
Practice Address - Country:US
Practice Address - Phone:540-371-7372
Practice Address - Fax:540-371-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08913Medicare PIN