Provider Demographics
NPI:1427421296
Name:COMMONWEALTH MEDICAL, LLC
Entity type:Organization
Organization Name:COMMONWEALTH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILPOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-668-2466
Mailing Address - Street 1:409 N PCH HWY # 166
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2870
Mailing Address - Country:US
Mailing Address - Phone:832-380-3626
Mailing Address - Fax:832-916-2127
Practice Address - Street 1:409 N PCH HWY # 166
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2870
Practice Address - Country:US
Practice Address - Phone:832-380-3626
Practice Address - Fax:832-916-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty