MEDICARE: NORTHPORT VAMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1215982897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHPORT VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94445
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4445
Country	:	US
Telephone Number	:	717-277-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8302
Country	:	US
Telephone Number	:	717-277-6565
Fax Number	:

Authorized Official
Title or Position	:	NPI TEAM MEMBER
Name	:	MS. ERIN POTTER
Credential	:
Telephone Number	:	202-382-2579

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/10/2023

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Directions to “NORTHPORT VAMC ” Practice Location

Language	Start Address	Practice Location

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