Provider Demographics
NPI:1912014424
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:MRS
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 1:36 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-8604
Mailing Address - Country:US
Mailing Address - Phone:717-896-3901
Mailing Address - Fax:717-896-2705
Practice Address - Street 1:36 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8604
Practice Address - Country:US
Practice Address - Phone:717-896-3901
Practice Address - Fax:717-896-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31970Medicare UPIN
PAP77588Medicare UPIN