Healthcare Provider Details

I. General information

NPI: 1932162674
Provider Name (Legal Business Name): MVAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD MVAMC
MANCHESTER NH
03104-7004
US

IV. Provider business mailing address

718 SMYTH RD
MANCHESTER NH
03104-7004
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-629-3263
Mailing address:
  • Phone: 603-624-4366
  • Fax: 603-629-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number011837-23-03
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number3283749465
License Number StateMA

VIII. Authorized Official

Name: DR. MARK LEVENSON
Title or Position: DIRECTOR
Credential: MD
Phone: 603-624-4366