Healthcare Provider Details

I. General information

NPI: 1457441289
Provider Name (Legal Business Name): VAMHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 OLD NEW MARKET RD
NEW MARKET MD
21774-6201
US

IV. Provider business mailing address

3901 THE ALAMEDA
BALTIMORE MD
21218-2100
US

V. Phone/Fax

Practice location:
  • Phone: 301-865-0799
  • Fax:
Mailing address:
  • Phone: 410-605-7651
  • Fax: 410-605-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberR160513
License Number StateMD

VIII. Authorized Official

Name: DR. SANDRA MARSHALL
Title or Position: DIRECTOR MANAGED CARE
Credential: MD
Phone: 410-605-7000