Provider Demographics
NPI:1457547994
Name:COMMONWEALTH OBSTETRICS GYNECOLOGY PC
Entity Type:Organization
Organization Name:COMMONWEALTH OBSTETRICS GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-349-0100
Mailing Address - Street 1:428 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3026
Mailing Address - Country:US
Mailing Address - Phone:540-349-0100
Mailing Address - Fax:540-349-4401
Practice Address - Street 1:428 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3026
Practice Address - Country:US
Practice Address - Phone:540-349-0100
Practice Address - Fax:540-349-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336118553OtherTYPE 1 NPI
VA204531OtherANTHEM
1043356132OtherTYPE 1 NPI
VA417859OtherMAMSI HEALTH PLANS
VA006211551Medicaid
VAF61199Medicare UPIN
VA204531OtherANTHEM