Provider Demographics
NPI:1275707812
Name:VA PUGET SOUND HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA PUGET SOUND HEALTH CARE SYSTEM
Other - Org Name:DEPARTMENT OF VETERN AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NILAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-273-0629
Mailing Address - Street 1:307 S 13TH ST
Mailing Address - Street 2:#200
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4100
Mailing Address - Country:US
Mailing Address - Phone:360-848-8500
Mailing Address - Fax:
Practice Address - Street 1:307 S 13TH ST
Practice Address - Street 2:#200
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4100
Practice Address - Country:US
Practice Address - Phone:360-848-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH097841261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA