Basic Information
Provider Information
NPI: 1316997356
EntityType: 2
ReplacementNPI:  
OrganizationName: HAMPTON VAMC
LastName:  
FirstName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: PO BOX 89496
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441016496
CountryCode: US
TelephoneNumber: 8282572333
FaxNumber:  
Practice Location
Address1: 100 EMANCIPATION DR
Address2:  
City: HAMPTON
State: VA
PostalCode: 236670001
CountryCode: US
TelephoneNumber: 8282572333
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 04/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: POTTER
AuthorizedOfficialFirstName: ERIN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: NPI TEAM MEMBER
AuthorizedOfficialTelephone: 2023822579
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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