Provider Demographics
NPI:1457441289
Name:VAMHCS
Entity Type:Organization
Organization Name:VAMHCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-605-7000
Mailing Address - Street 1:3901 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2100
Mailing Address - Country:US
Mailing Address - Phone:410-605-7651
Mailing Address - Fax:410-605-7685
Practice Address - Street 1:5611 OLD NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6201
Practice Address - Country:US
Practice Address - Phone:301-865-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160513261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA