Healthcare Provider Details

I. General information

NPI: 1730564980
Provider Name (Legal Business Name): BUFFALO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050A MOUNT BELVEDERE BLVD
FORT DRUM NY
13602-5438
US

IV. Provider business mailing address

PO BOX 94434
CLEVELAND OH
44101-4434
US

V. Phone/Fax

Practice location:
  • Phone: 717-277-6565
  • Fax:
Mailing address:
  • Phone: 717-277-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIN DENISE POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579