Provider Demographics
NPI:1972616431
Name:COMMONWEALTH FAMILY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH FAMILY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:276-632-3841
Mailing Address - Street 1:445 COMMONWEALTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2014
Mailing Address - Country:US
Mailing Address - Phone:276-632-3841
Mailing Address - Fax:276-632-2437
Practice Address - Street 1:445 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-632-3841
Practice Address - Fax:276-632-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA466796OtherANTHEM GROUP NUMBER
VACB1505OtherRAILROAD MEDICARE GROUP #
VAC01513Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER