Provider Demographics
NPI:1760597637
Name:COMMUNITY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:717-652-7266
Mailing Address - Street 1:3601 N PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9100
Mailing Address - Country:US
Mailing Address - Phone:717-652-7266
Mailing Address - Fax:717-652-5042
Practice Address - Street 1:3601 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9100
Practice Address - Country:US
Practice Address - Phone:717-652-7266
Practice Address - Fax:717-657-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC14568OtherR R MEDICARE
PAC14568OtherR R MEDICARE
PAB40620Medicare UPIN
PAP49320Medicare UPIN
PAC31970Medicare UPIN
PAP77588Medicare UPIN
PAD71203Medicare UPIN
PAQ67024Medicare UPIN
PAP71403Medicare UPIN