Provider Demographics
NPI:1023023769
Name:DEPT. OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPT. OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TATIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-623-8411
Mailing Address - Street 1:1 VA CTR
Mailing Address - Street 2:RADIOLOGY, VA TOGUS
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6719
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-621-4873
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:RADIOLOGY, VA TOGUS
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24251282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital