Provider Demographics
NPI:1568558021
Name:DAYTON VA MEDICAL CENTER
Entity Type:Organization
Organization Name:DAYTON VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHDAA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-268-6511
Mailing Address - Street 1:1730 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040814282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital